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HIGH DEMAND Low national unemployment numbers are forcing many businesses to scramble to find well-qualified, highquality employees. Hospitals and health care organizations are facing employment challenges of their own – especially when it comes to hiring and retaining qualified perioperative nurses.

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news & notes

American Surgical Professionals Announces New Vice President American Surgical Professionals has named Matthew C. French vice president of surgical operations, reporting to Thomas Kirk, chairman and CEO. In this role he will have responsibility for all surgical assist operating activities specifically, enhancing client satisfaction and relationships; attracting, retaining and developing quality surgical assistants; overseeing case load management and scheduling; ensuring employee technical and clinical competence; identifying new growth opportunities; monitoring payer reimbursement conditions and directing the regulatory affairs efforts. French brings almost 20 years of hospital, medical group and alternative health care delivery venue operations as well as a track record of successful business development to this position. Most recently, French was vice president of physician practice operations; and before this, he served as associate vice president at Memorial Hermann Medical Group in Houston. This group employs more than 300 providers, 900 administrative and support staff serving patients in 80 locations. •

Anesthesia Business Consultants Celebrate 40th Anniversary Anesthesia Business Consultants (ABC), a provider of billing and practice management for the anesthesia and pain management specialty, is celebrating its 40th year serving the anesthesiology specialty. “Since 1979, ABC has provided billing and accounts receivable management and practice management services to anesthesiologists, certified registered nurse anesthetists (CRNAs) and facilities that employ them. What sets ABC apart is its commitment to people, process and technology,” according to a press release. ABC is headquartered in Jackson, Michigan, with regional offices in Oregon, Texas, Massachusetts and California, along with approximately 80 other local offices throughout the country. “ABC’s growth as a company has been organic and strategic,” according to the press release. “ABC serves upwards of 8,000 anesthesia providers in almost every state throughout the U.S.” • For more information, visit www.anesthesiallc.com.

New ASTM International Standard Supports Surgical Implant Safety A new ASTM International standard aims to help determine the safety of surgical implants and prevent potentially adverse effects on patients. ASTM’s committee on medical and surgical materials and devices (F04) developed the standard (to be published as F3306). The new test method assesses metal and other ions released from single-use, metallic, implantable medical devices and components of such devices. The test involves putting the devices and components in a container with solutions that simulate the in-vivo environment and temperature. Samples are then taken at intervals. “The broad scope of the new standard covers a wide range of medical devices, including endovascular de-

10 | OR TODAY | APRIL 2019

vices, orthopedic implants dentistry-related items,” says ASTM International member Matthias Frotscher, senior manager of stent and material testing at Biotronik. “This standard will ensure that the medical device industry and notified bodies now have a standardized and widely accepted test method available for evaluation and comparison.” Frotscher says that implant manufacturers, regulatory agencies, consumers and laboratories could all benefit from the new standard. Once users have gained experience with the new standard, the committee plans to launch an interlaboratory study to further refine the standard with a precision-and-bias statement. •

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INDUSTRY INSIGHTS

news & notes

FDA Approves Cook Medical’s Aortic Dissection Device Cook Medical announced approval from the FDA for its Zenith Dissection Endovascular System. The system, consisting of a proximal stent-graft component and a distal bare stent component, provides physicians a less-invasive alternative to open surgery for repair of Type B dissections of the descending thoracic aorta. The device will be available for sale in the U.S. in the coming months. “We’re pleased to provide another minimally invasive option for aortic repair,” said Mark Breedlove, vice president of Cook Medical’s vascular division. “The approval of this product gives us an opportunity to have a positive impact on the lives of patients with aortic dissections.” “Cook Medical is committed to developing a variety of treatment options for aortic disease – from the arch to the iliacs, in order to help physicians fit a device to each patient’s unique disease state,” Breedlove said. •

FDA Clears Remote Patient Monitoring Solution Current Health, an artificial intelligence (AI)-powered wearable has received Class II clearance from the U.S. Food and Drug Administration (FDA) for hospital care. Current is a wireless device that continuously and automatically monitors patients to help better determine health trajectory and allows clinicians to intervene earlier. Current is an all-in-one wireless wearable approved for use in the EU and U.S. The company’s proprietary algorithms continuously analyze data, along with relevant contextual patient information, to offer actionable and proactive insights into the wearer’s health. It seamlessly integrates with third-party devices to capture additional metrics, building patient-specific digital therapeutics and recommendations.

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Current is actively in use with U.K. health care providers in a post-acute setting, including Dartford and Gravesham NHS Trust, which serves a local population of 500,000 people. The Dartford and Gravesham NHS Trust Hospital at Home team uses Current to remotely monitor patients after discharge. As a result, clinicians and staff reprioritized home visits based on criticality, resulting in a 22 percent reduction in home visits and fewer hospital readmissions and emergency department visits, which freed up skilled nursing time and helped patients feel safe and secure. Current demonstrated its FDA-cleared solution at the HIMSS19 trade show in Orlando. Additionally, CEO Christopher McCann presented “Deriving actionable insights from RPM and telehealth” at the Healthcare of the Future Pavilion. •

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INDUSTRY INSIGHTS

news & notes

IMO Announces Availability of Periop IT Content Intelligent Medical Objects (IMO) and AORN Syntegrity have announced that the Periop IT content is available in the Epic Foundation System. “IMO is excited to bring customers another piece of our product portfolio, providing better starting points to Periop IT content with Epic,” said Ann Barnes, CEO of IMO. Periop IT streamlines the standardization of surgical scheduling dictionaries and maps them to health care code sets, such as CPT-4 and ICD10PCS. Hospitals may achieve benefits such as maximum reimbursement, accurate scheduling and improved definitions of workflow efficiencies for the perioperative setting. By delivering quality content within a hospital’s EHR that is accessible for perioperative members, utilization and satisfaction can be enhanced across all care teams. Periop IT content allows clients to be able to more efficiently leverage the leading perioperative expertise of AORN Syntegrity, a subsidiary of the Association of periOperative Nurses (AORN), and IMO, the developer of the most widely accepted medical terminology solution for the management of medical vocabularies and software applications at health care organizations worldwide. Periop IT enhances claims and reporting workflows, optimizes communication and strives to improve patient outcomes, procedure scheduling, and reduce operation and IT workloads. “AORN Syntegrity and IMO have been helping health care organizations with their surgical content for years. Using Periop IT will help hospitals work toward improving patient outcomes and streamlining their content to improve billing and scheduling efficiencies,” said Janice Kelly, MS, RN-BC, president of AORN Syntegrity. •

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CommonSpirit Health Launches as New Health System Dignity Health and Catholic Health Initiatives (CHI) have come together as CommonSpirit Health, creating a new nonprofit Catholic health system focused on advancing health for all people and serving communities in 21 states. The $29 billion system operates more than 700 care sites and 142 hospitals, as well as research programs, virtual care services, home health programs and living communities. CommonSpirit Health also supports a range of community health programs to create healthier communities and address the root causes of poor health such as access to quality care and health equity, affordable housing, safe neighborhoods and a healthy environment. The new organization is built on the legacy of 17 congregations of women religious who founded health ministries to serve people most in need. Today, it is supported by approximately 150,000 employees and 25,000 physicians and advanced practice clinicians. Catholic Health Initiatives CEO Kevin E. Lofton and Dignity Health President and CEO Lloyd H. Dean will both serve as CEOs in the Office of the CEO for the new health system. CommonSpirit Health will focus on achieving success in five key areas: • Expanding clinical expertise across the system in primary, acute, and specialty care, and focusing on care for patients with chronic and complex conditions; • Accelerating the shift toward providing services outside of hospitals to homes, the community,and online; • Investing in technologies that make care more convenient and personal; • Addressing the underlying causes of poor health and advocating for policies that improve health outcomes for the most vulnerable members of our communities; and • Retaining and recruiting a highly-skilled and dedicated workforce where people embrace service to others and experience a personal and professional fulfillment in their work. CHI and Dignity Health previously announced that the new ministry will retain the names of local facilities and services in the communities where they are located. • Additional information is available at commonspirit.org.

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news & notes

CONMED Completes Acquisition of Buffalo Filter LLC CONMED Corporation has completed its previously announced acquisition of privately held Buffalo Filter LLC (Buffalo Filter) from Filtration Group. Buffalo Filter is the market leader in surgical smoke evacuation technologies. The company’s comprehensive product portfolio includes smoke evacuation pencils, smoke evacuators

and laparoscopic solutions. The original announcement of the acquisition and related presentation can be found on the “Investor Relations” section of the company’s website at www. conmed.com. The transaction is being financed through a combination of the net proceeds of the company’s new 2.625 percent convertible notes, which were

issued on January 29, 2019, borrowings under the company’s amended and restated credit facility, and cash on hand. The company plans to provide additional guidance regarding the impact of the transaction on 2019 financial results when it reports first quarter financial results in late April. •

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Deloitte, Orbita Team Up Health care information technology is undergoing unprecedented change. At this year’s HIMSS conference, Deloitte and Orbita worked together to transform the patient journey using DeloitteASSIST and the Orbita Voice platform. DeloitteASSIST is a voice-enabled patient communication solution where patients request assistance without the need to press a button. Simply by speaking their request, nurses are alerted to their need, which routes requests to the right resource to meet the patient’s needs. DeloitteASSIST reimagines the patient assistance journey by facilitating data-rich communication pathways between the nurse and the patient. Orbita Voice is the first enterprisegrade platform for developing and maintaining secure voice assistants, chatbots and other conversational interfaces for health care applications. Orbita Voice provides tools and a framework that allow organizations to design, build, manage and optimize Natural Language Processing (NLP) applications. With Orbita’s omnichannel publishing capabilities, organizations can efficiently deploy conversational application across all voice and chat channels including Amazon Alexa and Google Assistant as well as, web, mobile, text, IVR and social platforms. •

14 | OR TODAY | APRIL 2019

DowDuPont Launches New Soft Skin Adhesive for Medical Devices DowDuPont Specialty Products Division has introduced its new Dow Corning MG 7-1020 Soft Skin Adhesive, the latest addition to a growing portfolio of solutions for skin-adhered medical devices. Based on advanced silicone technology, this product delivers strong adhesion and extended wear, as well as design and manufacturing flexibility – while avoiding the skin irritation and discomfort more common with the removal of acrylic adhesives. Dow Corning MG 7-1020 Soft Skin Adhesive can be used with fabric backing and addresses the health care industry’s growing focus on biologic drugs that call for innovative delivery mechanisms such as patch pumps. Dow Corning MG 7-1020 Soft Skin Adhesive delivers strong adhesion and extended wear, as well as design and manufacturing flexibility for wearable devices. “Our continuous investment in innovative materials such as this new soft skin adhesive is designed to help medical device companies develop the next generation of skin-adhered solutions for effective, comfortable monitoring and treatment,” said Marie Crane, global medical device leader for DowDuPont Specialty Products Division. “This versatile, strong, yet gentle high-performance adhesive offers benefits to device designers, manufacturers, clinicians and patients. It can play an important role in the usability and efficacy of tomorrow’s wearable technologies and drug delivery devices.” •

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Medtronic Launches Mazor X Stealth Edition in U.S. Medtronic plc announced the first U.S. patients treated with the Mazor X Stealth Edition for spine surgery following its recent commercial launch. The Mazor X Stealth Edition offers a fully integrated procedural solution for surgical planning, workflow, execution and confirmation. The system was first used at Norton Healthcare in Louisville, Kentucky, and Reston Hospital Center in Reston, Virginia. “It is rare that huge sectors of technology such as robotics and navigation merge into a sole platform as found in the Mazor X Stealth Edition. Combined, these may provide more predictable and reliable execution of our procedure workflows,” remarked Jeffrey Gum, M.D., orthopedic spine surgeon at Norton Leatherman Spine. “Computerized surgical planning, 3-D assessment of spine anatomy, robotic guidance and live navigation feedback are designed to provide a higher degree of accuracy throughout the surgical procedure.” Co-developed between Medtronic and the recently acquired Mazor Robotics, the Mazor X Stealth Edition seamlessly incorporates Stealth software technology into the Mazor X roboticassisted surgery platform to deliver workflow predictability and flexibility through real-time image guidance, visualization and navigation informed by interactive 3-D planning and information systems. “The marriage of robotics and navigation represents the future of computerized planning and execution in spine surgery. Robotics and navigation have both been shown to improve accuracy and precision in spine surgery,” commented Christopher R. Good, M.D. F.A.C.S., spine surgeon at Reston Hospital Center, director of Scoliosis & Spinal Deformity and president of The Virginia Spine Institute. “The Mazor X Stealth Edition is a revolutionary new technology that uses cutting-edge software to plan the surgical procedure, then uses a robotic arm to guide implants and instruments through the steps of the surgical procedure with precision, while simultaneously using real-time imaging feedback to ensure the plan is being carried out as desired.” The Mazor X Stealth Edition was cleared by the U.S. Food and Drug Administration in November 2018. The system is now available in the U.S. and is expected to launch in key regions throughout the year. •

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Novant Health Selects Genesis Automation for Enterprise Supply Chain Novant Health has selected Genesis Automation’s Enterprise Supply Chain Management solution to enable system-wide visibility of inventory on hand, better clinician adoption and utilization of products and improved procedural documentation. Novant Health will use the Genesis Enterprise Inventory Point-of-Use Platform to manage materials arriving at and dispersed through its Logistics Center (cen-

tral supply warehouse) located near Charlotte, N.C. as well as supplies arriving directly to each of their 15 acute care hospitals. The Inventory Management and Clinical Point of Care modules will give staff at each facility visibility to their inventory and allow them to track movement throughout the hospital. The solution supports patient safety, allowing Novant Health to capture key implant, equipment and supply

information at the Point of Care. The Genesis Enterprise solution will be integrated to Novant Health’s Electronic Health Record (EHR) and Enterprise Resource Planning (ERP) systems for in-depth patient safety reporting, outcomes analyses, case costing, purchasing, A/R reconciliation and forecasting intelligence. • For more information, visit www.genesisahc.com.

Summit Medical Expands Manufacturing Operations Summit Medical, an Innovia Medical Company, announced the addition of a 15,000-square-foot facility that will serve as a secondary facility to its headquarters. The new space will support Summit Medical and Innovia Medical as a master distribution center and will allow for improved efficiencies across all product lines. Summit Medical specializes in various medical device product lines such as ENT products, ophthalmic products, jaw fixation products under the Minne Ties brand, and instrument protection trays and care and maintenance products under the InstruSafe brand.

“The addition of our master distribution and manufacturing center allows us to support Summit Medical’s significant growth in the Midwest and the Twin Cities, as well as Innovia Medical’s global operations,” said Kevin McIntosh, president of Summit Medical. “Customers shouldn’t expect any variation in billing or inquiries completed via the corporate office but may experience faster order fulfillment.” • For more information, visit www.summitmedicalusa.com.

Seth Hendee Joins Healthmark Industries Seth Hendee has joined Healthmark Industries as an clinical education coordinator where he provides clinical expertise on medical device processing, SPD education and standards interpretation. Prior to joining Healthmark, he has had over 20 years of experience as a central services professional. Responsible for many sterile processing roles, he primarily focused on education for the last eight years. He was responsible

16 | OR TODAY | APRIL 2019

for providing continuing education to ensure the SPD staff remained certified and were conversant about the latest trends and requirements of a sterile processing area. He also had responsibility for competence verification and documentation activities within the department. Hendee is a Certified Registered Central Service Technician, a Certified Instrument Specialist, a Certified Endoscope Reprocessor, a Certified

Healthcare Leader and an Approved Instructor through IAHCSMM. He is also a Certified Flexible Endoscope Reprocessor through the CBSPD. He participates in a number of AAMI Sterilization Standards Work Groups, including those responsible for ST79, ST91 and ST90. •

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INDUSTRY INSIGHTS CCI

Professional Development Through Volunteering with CCI By Emily Schenderlein he Competency and Credentialing Institute (CCI) offers diverse volunteer opportunities for perioperative nurses. You can leverage your expertise as a Certification Coach at your facility, serve on one of CCI’s governing bodies (Certification Council or Board of Directors), build and review a comprehensive professional development program as part of the Recertification Committee, develop the credentialing exams on a Test Development Committee or write practice exam questions with an Educational Product Development Committee. The purpose of this article is a more in-depth look at volunteering with CCI’s Test Development and Educational Product Development committees.

Perioperative nurses volunteer with CCI for a multitude of reasons. These include contributing to the advancement of the perioperative profession, enhancing their knowledge base and expanding their network with colleagues from around the country. Whatever the motivation for becoming involved without the dedication of volunteer contributions and the promoting of professional competency in the perioperative field, CCI could not offer exceptional credentialing services. Educational Product Development Committees allow credential holders the ability to write, reference and review questions for CCI’s CNOR and

18 | OR TODAY | APRIL 2019

CSSM exam preparation. All volunteers are provided with hands-on training to include materials (templates, guidelines, textbooks, etc.) on writing appropriate practice exam questions supporting CCI educational products to include the following: • Online practice exam • Flashcards • Exam prep book While the focus of our Educational Development Committees is to produce preparatory materials for the CNOR and CSSM exams, CCI’s Test Development Committees give volunteers the opportunity to directly support CCI’s perioperative credentials. The CNOR and CSSM exams undergo rigorous test development processes to ensure current and accurate exam questions. A diverse selection of volunteers is required by our accreditation agencies. CCI must include test development volunteers with a wide range of experience, education levels and demographic ranges to fulfill accreditation requirements. Volunteers who participate on a test development committee incorporate their knowledge and skills gained throughout their perioperative career in constructing a sound exam. Below are few of CCI’s Test Development committees: • Job Analysis • Form Review • Problem Item Notification (PIN) Call The Job Analysis defines the tasks and knowledge necessary for competent performance by a perioperative registered nurse with the minimum qualifications for the respected credential. The

Job Analysis defines essential competent performance and results in an exam blueprint. The Form Review is the ultimate check and balance to validate the final versions of CCI’s exam forms. Exam questions are reviewed for correctness, geographic bias, clarity and sound reference in the current literature. The Problem Item Notification (PIN) Call reviews exam questions that performed outside normal parameters and remediates and corrects these items as needed. Perioperative nurses who have attained a CCI credential (CNOR, CNSCP or CSSM) must validate professional continued competency through recertification at designated intervals. This encourages certified nurses to engage in lifelong learning in the perioperative field. CCI is excited to facilitate this learning through unique volunteering opportunities. If you are selected to be on a CCI volunteer committee and you complete your service, you will receive points applicable toward the recertification of your respected credential. Finally, CCI covers all travel costs associated with in-person meetings. Interested these opportunities? Applications for 2020 activities will be available in April 2019! Questions? Please contact volunteer@ccinstitute.org for more information. Emily Schenderlein is the Credentialing Specialist & Volunteer Coordinator for the Competency and Credentialing Institute.

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The sterile field should be covered if it will not be immediately used or during periods of increased activity. – AORN 2019*

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AORN Guideline for Sterile Technique. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc. 2018: electronic release.*

INDUSTRY INSIGHTS

IAHCSMM

AORN’s Updated Guideline for Sterilization By Rose Seavey he Association of periOperative Registered Nurses (AORN) published its updated Guideline for Sterilization in September 2018. The guideline covers recommendations for sterilization of reusable medical devices by steam, dry heat, as well as low-temperature methods (including ethylene oxide, hydrogen peroxide gas plasma or vapor, ozone combined with hydrogen peroxide, and peracetic acid).

In addition to addressing the various sterilization methods, this guideline, which was last updated in 2012, covers how to: • Load sterilizers; • Transport sterile items; • Perform sterilization quality control; and • Install and maintain sterilization equipment. In preparation for the update, the guideline underwent a strict evidence review process. Using the AORN Evidence Rating Model, recommendations were rated based on the quality and quantity of similar published evidence and then were given an appraisal score (the evidence score is placed in brackets after each applicable reference). For example, Recommendation 1.a. “Items that enter sterile tissue, including the vascular system, should be sterile when used.” [1: Strong Evidence]

What’s new in the guideline? This article highlights some of the updates and newly recommended practices covered in this updated guideline.

Sterilize whenever possible The guideline discusses the current scientific debate on the need to update the Spaulding classification system

20 | OR TODAY | APRIL 2019

due to newly identified pathogens that are resistant to high-level disinfection (HLD). Some devices may no longer belong in the semi-critical category. Many devices (e.g., endoscopes) that have historically been considered semicritical and processed by HLD have an increased risk of transmitting infections from one patient to another compared to those that were sterilized. AORN now recommends “Reusable semicritical items that are manufacturer-validated for sterilization should be sterilized if possible.” [3: Moderate Evidence] Fortunately, today, there are new and updated low-temperature sterilizers that are cleared by the U.S. Food and Drug Administration (FDA) for processing items such as endoscopes.

Sterile Storage Recommendation IV in the guideline states “Sterile items should be stored in a controlled environment.” We know that shelf life is reliant on many factors, such as packaging material, storage conditions, transport and handling. While this recommendation isn’t totally new, it now states: “The shelf life should be event-related unless otherwise specified by the packaging system manufacturer’s labeled expiration date.” [4: Limited Evidence]

Recommendation IV.b.2. states that “Sterile items outside a designated sterile storage room should be stored in closed cabinets or covered carts.” While there is limited evidence, it makes sense because controlled conditions reduce the risk of contaminating sterile items. More information on this can be found in the AORN Guideline for Design and Maintenance of the Surgical Suite.

Phacoemulsification handpieces A new recommendation in the guideline is to ensure packages containing phacoemulsification handpieces are positioned and held upright during the steam sterilization process. Current evidence shows that sterilization is more likely to be achieved when the channels of these handpieces are orientated vertically – with no obstruction at the end of the channel – so they can drain freely during steam sterilization.

Immediate-use steam sterilization (IUSS) IUSS should only be performed by competent personnel who use the right equipment in the right setting. For IUSS to be effective, all appropriate conditions must be met, including following the manufacturer’s instructions for use (IFU) for: • Cleaning; • Cycle type; • Exposure times; • Temperature settings; and • Drying (if recommended) Containment devices must be validated by the FDA for IUSS cycles. Steps should be taken to prevent contamination during transport. WWW.ORTODAY.COM

Assess environmental effects

Wet loads/packs AORN recommends that “Wet loads or wet packs in a terminal sterilization cycle should be investigated and corrective measures taken.” [4: Limited Evidence] After complete terminal sterilization cycle that includes drying may indicate a problem with the steam supply, sterilizer function or load configuration. The guideline describes practical approaches to investigating the causes of wet loads/ packs.

Recommendation XI of the guideline states that “The health care organization may establish a strategy for shutting down idle steam sterilizers.” It goes on to discuss the need for environmental safety and responsibility for strategies for sterilization, such as energy consumption, harmful emissions, toxicity, cost reduction, etc. AORN encourages an interdisciplinary team to evaluate sterilization purchases and usage decisions. XI.a. recommends that “The health care organization may establish a strategy for shutting down idle steam sterilizers.” [3: Moderate Evidence]

Sterile Processing leadership A new recommendation in the guideline is for health care facilities to assign responsibility and authority for leadership of the sterile processing team to qualified per-

sonnel. A high degree of expertise is needed due to the complexity of sterilization processes together with ever-changing technologies and instrumentation. Note: This article only covers some of the newly updated recommendations for sterilization, based on current evidence related to sterilization. Readers are encouraged to review and follow the entire guideline in order to help reduce risks to patients and staff.

Resources Association of periOperative Registered Nurses. Guideline for Sterilization. In: Guidelines for Perioperative Practice. 2018. Hauk, L. Guideline First Look. AORN Journal. Aug. 2018, Vol. 108. No. 2, pp. 10-12. – Rose Seavey, MBA, BS, RB, CNOR, CRCST, CSPDT, is President/CEO of Seavey Healthcare Consulting and former Director of the Sterile Processing department at The Children’s Hospital of Denver.

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INDUSTRY INSIGHTS ASCA

Support Grows, but True Quality and Price Transparency Remain Elusive By William Prentice ith its recent release of a new online price comparison tool for Medicare patients looking for information about outpatient surgery and a new requirement that hospitals make their prices publicly available, the Centers for Medicare & Medicaid Services (CMS) is sending a clear message that those who steer the U.S. Medicare program are concerned about the high cost of health care and want patients to have improved access to information about the cost of their care. Like many things in health care, however, while both the new tool and the new requirement are steps in the right direction, both have a lot further to go before they can truly achieve their end goal.

Everyone from individual patients trying to determine the cost of the procedure they need to veteran New York Times health reporter Robert Pear has recognized the difficulties hospitals face in posting prices that are meaningful and useful to patients. “The data, posted online in spreadsheets for thousands of procedures,” says Pear about the hospital reports, “is incomprehensible and unusable by patients – a hodgepodge of numbers and technical medical terms, displayed in formats that vary from hospital to hospital. It is nearly impossible for consumers to compare prices for the same service at different hospitals because no two hospitals seem to describe services in the same way. Nor can consumers divine how much they will have to pay out of pocket.” At the same time, Pear reports that the execution of the plan leaves much to be desired, he acknowledges that the new requirement, by most accounts, has been established in

22 | OR TODAY | APRIL 2019

pursuit of a worthy goal. According to CMS Administrator Seema Verma, that goal is to empower patients. Medicare’s new Procedure Price Lookup Tool suffers from some of the same shortcomings as the online databases the hospitals are posting. For example, using the medical coding system and terminology built into the tool, patients often find it difficult to identify the service or procedure they need. When they do, they can easily underestimate the cost involved by overlooking other services or procedures that need to be performed at the same time. Medicare patients who use the price lookup tool need to remember that the prices they are being given, both for the total cost of procedures and the patient copays, are averages that do not account for regional price variations. Patients covered by a supplementary Medicare plan or other insurance could also find dramatically different prices for their procedures. Right now, because of an anomaly in the ASC and hospital outpatient department (HOPD) reimbursement system that the Washington, D.C.-based think tank known as the Brookings Institution is calling a “poorly designed payment structure,” the patient copays for several high-cost procedures the tool covers have been capped when those procedures are performed in hospitals but not when they are performed in ASCs. As a result, to take advantage of modest savings in their copays, patients could elect to have the procedures they need at the higher cost provider where the costs to Medicare could be tens of thousands of dollars more. ASCA is looking at ways to address this situation. One problem both transparency tools share is a lack of quality data. Without information they can use to evaluate and compare the quality of care they can expect to receive WWW.ORTODAY.COM

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in different sites of service, patients might easily select the higher-priced provider in the mistaken belief that higher cost care is also higher quality care – a common misperception that has been disproven time after time in peer-reviewed studies of many kinds. Of course, in emergency situations, Sales, Service, Repairs it is difficult if not impossible for patients to compare costs and providers, but patients considering outpatient surgery for elective procedures often have time to evaluate their options. To help, many ASCs across the country are working with their patients and their insurance providers before a scheduled surgery to determine the cost of care. Some ASCs are also posting prices online, and many are participating in state and national reporting programs created to collect and share price and quality data with consumers. Long story short,PUBLICATION the more transMEDICALbecome DEALER TECHNATION ORTODAY parent providers and insurers with price and qualityBUYERS metrics,GUIDE the OTHER more providers and consumers learn about the need for MONTH this information and the challenges involved in delivering it. Meaningful data J must F Mbe AeasyM J J A S O N D to access, easy to use and comparable DESIGNER: across sites of service. While weJLcontinue to move closer to that goal, we have only begun to explore this new territory and the work that lies ahead. As U.S. Secretary of Health and Human Services Alex M. Azar II said last year, “There is no more powerful force than an informed consumer.” ASCs are looking forward to working with our colleagues in health care to harness that power and put it to work improving patient health and patient access to affordable, high-quality outpatient surgical care across the U.S.

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APRIL 2019 | OR TODAY |

COMPANY SPOTLIGHT Medline

ReadyPrep™ CHG 2% Pre-Saturated Cloth for Preoperative Skin Preparation Skin colonization and surgical site infections Surgical site infections (SSIs) continue to present significant risks to patients undergoing a myriad of surgeries, as they increase morbidity, mortality, and healthcare costs.1 In combating SSIs, clinicians utilize a plethora of preoperative, intraoperative, and postoperative techniques. Given that multiple species of pathogenic bacteria frequently colonize the skin, preoperative preparation via cleansing near the incision site is commonly employed, since this practice reduces the bacterial load on the skin.2 By eliminating nearly all of the bacteria on the skin, cleansing reduces the potential for pathogens to colonize the incision site and cause an SSI.

ReadyPrep™ CHG 2% Pre-Saturated Cloth The application of single-use antiseptic wipes represents a demonstrable and convenient method to reduce bacteria on the skin. Chlorhexidine gluconate (CHG) is a widely-used antiseptic with significant, broad-spectrum, antimicrobial activity, coupled with a long-history of use and low incidence of adverse events.3 To facilitate preoperative skin preparation, Medline Industries, Inc. now offers ReadyPrep™ CHG Cloth, which contains two preoperative skin preparation cloths, each pre-saturated with a 2% CHG solution that is equivalent to 500 mg CHG per cloth.

Two successful clinical studies In two pivotal clinical trials, each with over 300 healthy subjects, ReadyPrep™ CHG Cloth1 significantly reduced the number of skin microorganisms when applied to a 5” × 5” location on the abdomen (non-sebaceous site) and a 5” × 2” location on the groin (sebaceous site).4,5 The design of both studies was identical and followed the guidance provided in the 1994 Food and Drug Administration Tentative Final Monograph for Over-the-Counter Healthcare Antiseptic Drug Products.6 Subjects were exposed to two

The formulation tested in these studies and all ReadyPrep™ CHG Cloth studies referenced contained two inactive ingredients not present in the final commercial formulation. An in vitro time-kill bridging study determined that the commercial formulation and the formulation used in the pivotal efficacy studies were equally effective.7 a

24 | OR TODAY | APRIL 2019

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COMPANY SPOTLIGHT Medline

of three treatments: ReadyPrep™ CHG Cloth, a 2% liquid CHG solution (active control), and a ReadyPrep™ CHG Cloth that contained no CHG (placebo control). The primary endpoint was the proportion of “responders” at ten minutes post-treatment application; a responder was a subject that demonstrated a reduction in skin microorganisms at the application site that exceeded a threshold suggested by FDA. Measurements of skin microorganisms were also made six hours post application to ascertain product efficacy on a longer time scale.

Significant reduction in skin microorganisms in ten minutes, with effects lasting up to six hours ReadyPrep™ CHG Cloth was the only treatment to meet the primary endpoint in both studies at both application sites. Application of ReadyPrep™ CHG Cloth significantly reduced the number of skin microorganisms, performing

equally as well or better than the active control (liquid CHG). Six hours after ReadyPrep™ CHG Cloth application, all subjects had skin microorganisms lower than the baseline levels measured prior to product application.

Favorable safety profile As part of the development of ReadyPrep™ CHG Cloth, more than 1,600 subjects in eight clinical studies were exposed to the product under conditions of therapeutic use.4,5, 8-13 There were zero reports of serious adverse events across these studies. Mild-tomoderate skin irritation at the application site composed the vast majority of side effects in these studies; irritation was temporary, resolved completely, and was consistent with the known effects of 2% CHG on skin. Moreover, a pharmacokinetic study in 12 subjects confirmed that cutaneous exposure of ReadyPrep™ CHG Cloth did not result in systemic exposure to chlorhexi-

1. Leaper D, Ousey K. Evidence update on prevention of surgical site infection. Curr Opin Infect Dis. 2015;28(2):158-163. 2. Septimus EJ, Schweizer ML. Decolonization in Prevention of Health Care-Associated Infections. Clin Microbiol Rev. 2016;29(2):201-22. 3. McDonnell G, Russell AD. Antiseptics and Disinfectants: Activity, Action, and Resistance. Clin Microbiol Rev. 1999;12(1):147-79. 4. Data on file. Medline Industries Study #R13-053. 5. Data on file. Medline Industries Study #R15-029. 6. Food and Drug Administration. Tentative final monograph for healthcare antiseptic drug products; proposed rule. Federal Register 1994; 59:31401-52. WWW.ORTODAY.COM

dine.11 Finally, a study with 210 healthy subjects employed a threephase immune sensitization protocol, and found that zero subjects displayed a reaction to the ReadyPrep™ CHG Cloth solution that would be indicative of a systemic immune response.14

ReadyPrep™ CHG Cloth: Convenient and efficacious preoperative skin preparation In two pivotal trials, Medline’s ReadyPrep™ CHG Cloth met the primary endpoint for efficacy in reducing skin microorganisms at ten minutes post-treatment, and the number of microorganisms remained suppressed six hours after initial treatment. By significantly reducing skin microorganisms, ReadyPrep™ CHG Cloth represents a critical tool in overall preoperative patient preparation to prevent surgical site infections. For more information, visit www.medline.com/pages/chg/

7. Data on file. Medline Industries Study #R17-004. 8. Data on file. Medline Industries Study #R13-052. 9. Data on file. Medline Industries Study #R15-029. 10. Data on file. Medline Industries Study #R16-034. 11. Data on file. Medline Industries Study #R17-023. 12. Data on file. Medline Industries Study #R13-042. 13. Data on file. Medline Industries Study #R14-015. 14. Data on file. Medline Industries Study #R13-051.

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INDUSTRY INSIGHTS

Hypothermia

Perioperative Nursing Knowledge

Unintended Hypothermia & Forced-Air Warming Systems By Christopher J. Hudgins

BACKGROUND Unplanned patient hypothermia is a preventable complication of surgery that has been identified as one of the top 10 patient safety concerns for perioperative nurses.1 It is well documented that unless preventative measures are taken, unintended hypothermia can occur in up to 90 percent of surgical patients.2 Forced-air warming is the most commonly used modality to prevent and treat this complication.3 Unfortunately, despite the abundance of research on both unplanned perioperative hypothermia and forced-air warming, there is little information regarding nursing knowledge on the topics.

METHODS A survey was developed and administered at the 2018 AORN Global Surgical Conference & Expo in New Orleans, Louisiana. The goal of this survey was twofold. The primary objective was to assess nursing knowledge of unplanned hypothermia. The second objective was to identify any knowledge gaps in the use of forced-air warming systems. Individuals attending an in-booth education session on the exhibit floor during the conference were asked to anonymously complete a questionnaire. Those who agreed were presented with a survey containing 8 questions. The first 3 questions centered on knowledge of unintended hypothermia and were multiple-choice. The remaining 5 questions were about the use of forced-air warming and were true/ false. The surveys were collected before the education presentation commenced.

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Eighty-six (86) surveys were included in the results. Surveys that contained responses that were illegible and surveys that were not fully completed were excluded. Individuals completing the survey identified their current position as: • Circulating nurse = 44 (51%) • Other = 13 (15%) • Operating room managers or directors = 13 (15%) • Educators = 7 (8%) • Registered nurse first assistants = 5 (6%) • Retired = 3 (3%) • Post-anesthesia care unit or pre-op nurse = 1 (1%) Those who marked “other” were instructed to write in an answer. They identified their current position as: charge nurse, clinical supervisor/leader, consultant, data/ business analyst and quality manager. For more information, visit ORToday.com/UnintendedHypothermia.

Christopher J. Hudgins, BS, ASN, RN, CNOR, is a Perioperative Clinical Specialist Manager in the Medical Solutions Division at 3M Health Care. He is also the President Emeritus and Board Member of AORN Atlanta Chapter 1101. 3M Health Care sells forced-air warming blankets and gowns.

REFERENCES 1. Steelman VM, Graling PR, Perkhounkova Y. Priority patient safety issues identified by perioperative nurses. AORN J. 2013;978(4);402-418. 2. Sessler DI. Mild Perioperative Hypothermia. New Engl J Med. 1997; 336(24):1730-1737. 3. Sun, Zhuo et al. “Intraoperative Core Temperature Patterns, Transfusion Requirement, and Hospital Duration in Patients Warmed with Forced Air.” Anesthesiology 122.2 (2015): 276–285. PMC. Web. 26 July 2018.

APRIL 2019 | OR TODAY |

INDUSTRY INSIGHTS

WEBINAR SERIES

webinars

OR Today Webinar Addresses Hair Removal in the OR Staff report The recent BD-sponsored webinar “VacuumAssisted Hair Removal In The OR; Value And Optimization” was a hit with operating room professionals. Lena Pearson, BSN, MHA, CNOR, Medical Science Liaison, Infection Prevention Surgical and Interventional Specialist for Becton Dickinson’s Infection Prevention Division discussed vacuum-assisted hair removal (ClipVac, BD) and how it is a proven surgical hair removal method that eliminates the need to use adhesive tapes to collect dispersed hairs from the operative field. She reviewed the rationale for surgical hair removal, the guidelines, data supporting the ClipVac system and tips to optimize its use in your OR. Pearson is a specialist in skin antiseptics, prepping techniques, surgical/vascular process improvement and standardization. She is accountable for the exchange of unbiased information with the health care community as a subject matter expert. Since joining BD in 2006, she has been a fundamental link between science, sales and the health care community by providing evidence-based data with a procedural focus to standardization in which she has published articles. She is accountable for researching protocols and surgical process standards for quality improvement. Webinar attendees shared positive reviews and comments on Pearson’s presentation. “The BD webinar for clipping and containing hair was very well done, lots of good information, especially regarding contamination and tape rolls, as well as the proper procedure for using the clipper to avoid damage to the skin,” said J. Schoen, Clinical Nurse Educator. “The webinar gave a great overview of the issues including infection issues and a demo of the product,” said L. Smithzuba, Director of Perioperative Services. “Informative webinar on a rarely talked about subject for infection prevention,” shared Dr. R. Mathias, Surgeon. “The presenter hits home with the main objectives and

28 | OR TODAY | APRIL 2019

“ The presenter hits home with the main objectives and keeps a very dialed in, detailed approach to what is most important regarding the topic.” – M. Imperati, Surgical Specialities Territory Manager.

keeps a very dialed in, detailed approach to what is most important regarding the topic,” said M. Imperati, Surgical Specialities Territory Manager. “The webinars provide those of us in the field a collaborative approach to reviewing evidence-based practice and allowing us to provide the best care possible to our patients,” said S. Mittler, Senior Clinical Consultant. “As a clinical engineer some topics may be outside of my scope practice but most of the webinars give me a deeper understanding of emerging technologies as well as the changes in practice since I worked in the OR,” J. Marsala, Director of Clinical Engineering. “I always appreciate the wide variety of webinars that OR Today provides. They are always helpful to our practice,” shared M. Gavilanez, RN, Infection Control Preventionist. For more information about OR Today webinars, visit ORToday.com. Thank you to our sponsor:

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INDUSTRY INSIGHTS Guide to IAHCSMM

Get a Fresh Perspective at IAHCSMM 2019 SUNDAY, APRIL 28 9-10 A.M. – Opening keynote speaker: Kevin Brown 10:15-11:15 A.M. – General Session: Joint Commission Update 11:30 A.M.-12:45 P.M. – Welcome lunch 1-2 P.M. – Certification Legislation 2:15-3:15 P.M. – Concurrent sessions (The Threshold between Success and Failure in CS; Infection Prevention 101; Vaporized Hydrogen Peroxide Sterilization: Riding atop a New Wave) 3:30-4:30 P.M. – Concurrent sessions (National Ultrasound Survey Reveals Need to Review Probe Reprocessing Policies; Water: The Utility That Makes SPD Work; Designing and Implementing Real Preventive Maintenance Programs) 4:30-5:30 P.M. – Membership meeting 6:30 P.M. – Opening reception MONDAY, APRIL 29 7-8 A.M. – Concurrent sessions (AAMI Roundtable Discussions; Unique Device Identifier Panel Discussion; Implementing a Certification-based Sterile Processing Career Ladder at a Regional, Multi-site Health System;

30 | OR TODAY | APRIL 2019

Steam Quality and Steam and Water Purity: The Missing Links in Successful Processing) 8:15-9:15 A.M. – Leveraging Scientific Evidence to Improve the Quality of Endoscope Reprocessing 9:30-10:30 A.M. – Concurrent sessions (How to Pour a Proper Guinness: Everything Has an IFU; AAMI/ AORN Standards Update; Reclaiming What’s Lost: Taking Control of Your Endoscope Process) 10:45-11:45 A.M. – Concurrent sessions (Centralizing High-level Disinfection; Training, Competencies, Work Instructions, Policies & Procedures, Oh My; Biofilm Housing Development: Work Surfaces, Devices, Cleaning Equipment) 11:45 A.M.-12:45 P.M. – Attendee lunch 1-5 P.M. – Vendor Exposition 6:30 P.M. – Cocktail reception TUESDAY, APRIL 30 7-8 A.M. – Concurrent sessions (AAMI Roundtable; You Had a Hand in That; Leadership in CS/SP: From the OR and in between; Surface Changes of Medical Devices: Prevention of Depos-

its, Discoloration and Corrosion) 8 A.M.-12 P.M. – Vendor Exposition 1:30-2:30 P.M. – Surgical Instruments or Equipment Contamination: Incident Investigation and Material Identification 2:45-3:45 P.M. – Concurrent sessions (Sterilization of Flexible Endoscopes; Onsite Sterile Processing vs. Offsite Sterile Processing: A Systematic Approach; Beyond Service: Maintenance of Sterile Processing Equipment) 4-5 P.M. – Concurrent sessions (Living with Loaners: The Struggle is Real; Global SPD Trends: What You Can Do with the Data to Make a Difference; A Toolbox for Chemical Management in Sterile Processing WEDNESDAY, MAY 1 8:30-9:30 A.M. – Point-of-Use Care and Transport of Contaminated Reusable Items 9:45-10:45 A.M. – View Through a Surgeon’s Eyes 11-11:30 A.M. – Closing remarks 11:30 A.M.-12:30 P.M. – Closing keynote speaker: Chef Jeff Henderson

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The International Association of Healthcare Central Service Materiel Management’s 2019 Annual Conference & Expo, taking place April 27-May 1 in Anaheim, California, will deliver a wide range of educational opportunities to help central service/sterile processing (CS/ SP) professional broaden their knowledge and give their departmental practices a boost. This year’s Conference & Expo theme is “A Fresh Perspective.” IAHCSMM is thrilled to bring attendees from across the globe an array of educational sessions taught by a thoughtfully curated cast of industry-leading experts and an opportunity to immerse themselves in the latest technology and innovation in products and services. Attendees will meet fellow CS/SP professionals, engage in problem-solving and best practice discussions and find fresh new ways to meet the needs of their

health care customers – and, above all, help ensure the delivery of safe, high-quality patient care. Attendees can earn up to 23 continuing education credits to apply toward their recertificaton (and even more CEs can be earned by participating in vendor-provided education during the Expo). Those arriving to Anaheim early can get a jumpstart on their learning by participating in pre-conference hands-on labs and workshops. Concurrent hands-on labs and workshops are offered to conference registrants at no extra charge. Other pre-conference workshops, including

the Educators Forum, A Fresh Look at CS Management, and StrengthFinderTM Workshop, are offered for an additional registration fee. All pre-conference education offerings are offered on a space-available basis. Early registration is recommended for the paid pre-conference session. What follows is an abbreviated summary of the 2019 Conference & Expo schedule. For more information, and to register, visit www.iahcsmm.org/events/annualconference-expo.html.

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product focus

Sterilization Equipment Market Worth Billions Staff report report on the sterilization equipment market by MarketsandMarkets sees continued growth. The sterilization equipment market is expected to reach $11.14 billion by 2023 from $7.94 billion in 2018, at a compound annual growth rate (CAGR) of 7.0 percent, according to a news release.

“The major factors driving the growth of this market are the rising incidence of hospital-acquired infections, increasing number of surgical procedures, rising focus on food sterilization and disinfection, technological advancements in sterilization equipment, and increasing number of hospitals in Asia. On the other hand, the presence of stringent regulations may restrain the growth of this market during the forecast period,” according to the MarketsandMarkets release. Sterilization instruments accounted for the largest market share in 2017, the release adds. “By product and service, the sterilization equipment market is classified into instruments, consumables

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and accessories, and services. The sterilization instruments segment accounted for the largest market share in 2017. The large share can be attributed to the growing incidence of HAIs and the growing volume of surgical procedures across the globe,” the release states. “On the basis of end user, the sterilization equipment market has been segmented into hospitals and clinics, medical device companies, food and beverage industry, pharmaceutical companies and other end users,” it adds. “The hospitals and clinics segment accounted for the largest share of the sterilization equipment market in 2017. The large share of this segment can be attributed to increasing incidence of healthcare-associated infections (HAIs), growing number of hospitals in Asian countries and increasing number of surgical procedures. North America is estimated to command the largest share of the market in new and future data. “In 2018, North America is expected to account for the largest share of the global sterilization equipment market. The increasing

demand for sterilization technologies from the health care industry to minimize the occurrence of HAIs and the increasing number of surgeries in this region are the major factors supporting the growth of the sterilization equipment market in North America,” according to the release, which was released before the 2018 data was available. Grand View Research also predicts market growth in the coming years. “The increasing number of surgical procedures and aging population are the major factors expected to propel the growth. In addition, the rise in the incidence of chronic diseases and various initiatives taken by the government to ensure adoption of essential sterilization standards in hospitals and research centers is expected to drive the growth of the sterilization equipment industry during the forecast period. Currently, stringent medical safety and infection control norms are increasing public awareness of the global population resulting in shorter hospital stays and lesser health care costs,” according to Grand View Research.

APRIL 2019 | OR TODAY |

IN THE OR

product focus

Getinge

9100E Cart Washer-Disinfector Getinge’s latest generation of cart washer-disinfectors incorporates critical design and performance enhancements that reflect evolving priorities and clinical mandates in the central sterile department. The new Getinge 9100E Cart Washer-Disinfector offers a combination of operational efficiency, cleaning efficacy and staff/patient safety for processing case carts, containers, bowls, basins, utensils and bulky equipment. All of this can be accomplished in a choice of a standard or one of the unit’s efficiency operating modes that conforms to the central sterile department’s reprocessing preferences and requirements. •

34 | OR TODAY | APRIL 2019

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IN THE OR

product focus

Healthmark Industries

Decontamination Gowns Decontamination Gowns from Healthmark Industries are designed for use in device reprocessing areas. The Decontamination Gowns meet AAMI PB70 Class 4 requirements for liquid barrier performance while providing a high level of strikethrough resistance in the most vulnerable zone, protecting health care workers from soil and bioburden when cleaning items. The single-use (one person-one day) Decontamination Gowns are comprised of two materials. The upper and lower zones are manufactured of a breathable material that is AAMI PB70 Class 4 that passes ASTM F1670 & F1671 test methods. The middle zone is manufactured of a completely liquid impervious zone, including preventing strikethrough of detergent cleaning solutions, even when physically leaning against sinks or other cleaning baths. The wrap-around Decontamination Gowns (360-degree coverage) come with elastic wrists, thumb loops, neck and waist ties long enough to tie in the front or back. Use of the gowns eliminates the need for a plastic apron or other secondary protection improving worker comfort and dexterity. â&#x20AC;˘ For more information, visit www.hmark.com.

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APRIL 2019 | OR TODAY |

IN THE OR

product focus

Medline Industries Inc.

Gemini Bonded Sterilization Wrap Gemini Wrapâ&#x20AC;&#x2122;s strong, dual-layer, 100 percent polypropylene construction provides high-level barrier protection against fluid and particulates. Designed to afford you greater confidence in your sterilization process, Gemini has a unique, blue/pink color combination and flat, basket weave pattern. The blue/ pink color combination makes it easier to identify imperfections, while the flat, basket weave pattern has a soft, smooth finish which is easy to handle and fold. Gemini wrap is indicated for use in all major sterilization cycles: pre-vacuum steam, gravity steam, ethylene oxide (ETO), STERRAD, Steris V-Pro and Sterizone VP4. â&#x20AC;˘ For more information, visit www.medline.com/go/cswrap.

36 | OR TODAY | APRIL 2019

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IN THE OR

product focus

Microsystems SPM

The evolving requirements of robotic instrumentation continue to place significant emphasis on resource intensive tasks. From lengthy decontamination processes, instrument use limits, and inventory management, robotics require an ongoing commitment to solve a range of unique challenges that must be met in order to ensure consistent, high-quality clinical outcomes. â&#x20AC;˘ For more information, visit www.mmmicrosystems.com.

Guided workflows for all aspects of reprocessing robotic instrumentation consistent with device IFUs.

Extensive value-based reporting and analysis capabilities.

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APRIL 2019 | OR TODAY |

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IN THE OR

CE462

continuing education

Joyce Lahue, MS, BSN, RN, CPHRM, FASHRM

Lines of Communication oes this sound familiar? A physician calls with telephone orders for one of your patients. It’s one of “those” days. The nurses station is frantic with activity and noise. Other phones are ringing, people are at the desk asking questions, admissions are coming in, discharges are waiting to go home, and here you are trying to get critical information from a physician over the phone. This was probably one of the scenarios that The Joint Commission had in mind when it addressed effective verbal/telephone communication between healthcare providers in its National Patient Safety Goals.1

In 1999, the Institute of Medicine published “To Err Is Human: Building a Safer Health System,” stating that between 48,000 and 99,000 people in the U.S. die each year due to medical error.2 Ineffective communication, including on the telephone, contributes significantly to these errors.2 What has changed is how we as consumers and healthcare providers look at patient safety. The IOM report helped to bring the issue of patient safety to the table for the public and practitioners. A 2013 review of four studies using the Institute for Healthcare Improvement Global Trigger Tool for adverse events estimated, on the low end, the number of deaths to be 210,000 directly associated with preventable harm in hospitals and estimated that 400,000 annually was a truer number.3 The Joint Commission has described communication problems as one of the leadWWW.ORTODAY.COM

ing causes of sentinel events, the unexpected incidents that result in death or serious, permanent injury to a patient — or the risk of such harm (a “near miss”). Other leading causes include human factors and/or ineffective leadership. Human factors include errors all humans are prone to making, such as forgetting to lock a door, turn on a light, or check an armband, and hurrying or taking shortcuts during busy work periods.4 The National Patient Safety Goals have included a category on communication in healthcare ever since their development in 2002.5 The communication goal started out with two safety measures: the read back of verbal/telephone orders and the use of standard abbreviations. In 2005, The Joint Commission added a third item, the timely and accurate reporting of critical lab results, and in 2006, a fourth, a requirement for standardizing “handoff” communications.6,7 Verbal telephone orders and handoff of communication became standards in 2010 and are no longer listed as National Patient Safety Goals. Also in 2010, The Joint Commission provided more detail about the requirements for communication of critical test results to the provider or person responsible to act on these results.8 Goals about communication continue on the National Patient Safety Goals, including improving staff communication.9 In review of the goals and data provided by The Joint Commission regarding the root causes of sentinel events, it is evident that communication continues to be a primary cause of sentinel events.10 From taking an order over the phone to handing off a patient to another department, all healthcare professionals face situations involving poten-

Relias LLC guarantees this educational activity is free from bias. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity. See Page 45 to learn how to earn CE credit for this module.

Goal and objectives The goal of this program is to impress upon nurses the importance of clear, accurate, and timely communication, both oral and written, in providing safe and effective care to patients. After studying the information presented here, you will be able to: • Describe the patient safety issues associated with transcribing verbal and telephone orders • List The Joint Commission’s unacceptable abbreviations, acronyms, and symbols • Discuss the importance of handoff communication and timely and accurate reporting of critical test results

tial communication problems every day. Healthcare professionals must understand and adopt safety practices to ensure the smooth functioning of the healthcare team — and the safety and optimal care of their patients. APRIL 2019 | OR TODAY |

IN THE OR

continuing education What Did You Say? Verbal or telephone orders are a significant source of medical errors. Errors can occur not only in the scene described above at the nurses station, but also when the person giving an order is difficult to understand. Think about all of the accents, dialects, and pronunciation patterns heard in almost any hospital these days — and how orders could be misinterpreted, leading to a medical error. Other dangers of telephone or verbal communication are interruptions, distractions, unfamiliar drug names or terminology, medications with sound-alike names, and reliance on memory when writing down an order at a later time.11 All are recipes for disaster. Another consideration is the speed with which verbal or telephone orders are carried out. Actions resulting from verbal and telephone orders usually occur right away, giving little time for correction if the person taking the order noted it erroneously. With verbal or telephone orders, the person giving the order has a natural tendency to expect that the person taking the order will understand it and copy it accurately into the medical record. But even if the person taking the order understands it, he or she may make an error in transcribing it. As part of its National Patient Safety Goals and the standards in which this goal is now addressed, The Joint Commission requires the person receiving a verbal or telephone order to write down the complete order or enter it into a computer as it’s being given and then read it back and receive confirmation from the person who gave the order. This ensures the accurate transcription of all verbal or telephone orders, not just the more common medication orders. The read-back process also applies to critical test results, which will be covered later. In emergencies, such as a code or during surgery in the OR, this read-back process may not be possible. In this case, a “repeat back” is acceptable.12 The best way to prevent errors resulting from verbal or telephone orders is to limit their use.11 But this is easier said than done. It’s much easier for the pro-

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vider to give a verbal or telephone order than to write it in the medical record. The Joint Commission suggests that organizations make the written process as easy as possible. Organizations have done this in various ways, including using preprinted order sheets with check boxes or having providers fax written orders if they aren’t onsite. Organizations fortunate enough to have computerized physician order entry may use handheld computers or easyaccess terminals to make it convenient for providers to enter their orders electronically.11 Additional suggestions to improve the verbal/telephone order process and ensure safety include:11 • Ask the provider for the correct spelling of a medication if you are unsure. • When repeating an order back to the provider, spell out numbers, e.g., 17 would be one — seven. • Avoid using abbreviations. For example, “1 tab t.i.d.” should be stated as “Give one tablet three times daily.” • Have a second person listen to the verbal/telephone order whenever possible, especially if an inexperienced healthcare professional is taking the order. • Record a verbal order directly onto the physician order sheet. This eliminates transcription as a source of error. • Limit the number of people who are allowed to receive verbal orders and be sure they are familiar with the verbal/ telephone order policy. • Restrict the use of verbal/telephone orders in certain areas, e.g., oncology, where chemotherapeutic drugs are involved. Any drugs that are high-risk and have complicated or sound-alike names should not be prescribed verbally. • Write the purpose of the drug on the order. The order should also include the drug name, dosage form, strength of concentration, frequency, route, quantity, and duration. Employees should take verbal/telephone orders only for things that are within their scope of practice, e.g., a ward clerk should not take a practitioner’s verbal order for patient-related issues.

Read back does make a difference, but it is often not used.13 In a review published in May 2017 about the challenges caused by verbal orders in medicine, it was noted that of 19% of the errors in medicine, a reported 2.3% were related to verbal orders.14

Devilish Details Another source of medication errors is dose designations that include decimal points. For example: A patient gets 10 times the normal dose of a medication, because the nurse did not see the decimal point in the “1.0” written by the physician, or an order for “.1 mg” is interpreted as “1 mg,” because the nurse doesn’t see the decimal point.15 Overdoses can easily result from using a trailing zero when none is needed, e.g., 1.0 mg instead of 1 mg, or failing to use a leading zero when writing a fractionated dose, e.g., .1 mg instead of 0.1 mg.15 The Joint Commission’s “Do Not Use” abbreviation goal is now part of the Information Management standards. The requirement is for facilities to have a standardized list of “Do Not Use” abbreviations to include the following dose designations, abbreviations, acronyms, and symbols:16 • The abbreviations “U” and “IU,” which can easily be mistaken for the number “0,” especially when the “U” is written too closely to the number. For example, a patient could receive 60 units of insulin because the nurse interprets “6U” as “60.” Or “IU” could be misinterpreted as “IV” or the number “10.” The safest way is to write out “unit” and “international unit.” • The abbreviation “q.d.” (every day), which can be read as “q.i.d.” (four times a day), especially if the period after the “q” or the tail of the “q” is misunderstood. Writing out “every day” will eliminate this error. Similarly, the abbreviation “q.o.d.” (every other day) can be seen as “q.d.” or “q.i.d.” if the “o” is poorly written. The correct form here is to write out “every other day.” • Trailing zeros and a lack of a leading WWW.ORTODAY.COM

IN THE OR

continuing education

zero. For example, “.2 mg” could be misread as “2 mg” if the decimal point is missed. A leading zero should be included so the text reads “0.2 mg.” • The last of The Joint Commission mandates on abbreviations relates to magnesium sulfate and morphine sulfate. When MgSO4 and MSO4 are written hastily, they can easily be confused. Write out magnesium sulfate and morphine sulfate so there can be no mistake as to which is intended.

Old Habits The Joint Commission recommendations on abbreviations have been difficult to enforce, largely because of ingrained behavior. Changing the order practices of physicians who have been writing orders the same way for 10, 20, or 30 years is challenging. The same can be said of clinicians and other professionals who take physicians’ orders verbally or telephonically and use nonstandard abbreviations on the order sheet or when transcribing orders to the medication administration record. The Joint Commission asked accredited hospitals how they handle the dangerous abbreviation issue. Several suggestions are:17 • Print an authorized abbreviation list at the top or bottom of order sheets or in the margins • Provide physicians and staff with pocket-size, laminated abbreviation cards with a hole on top so they can be hung with ID cards • Print an abbreviation list and laminate it to the physician orders section chart divider • Remove “Do Not Use” abbreviations from preprinted order forms • Educate, monitor, and provide feedback to physicians and staff who document in the medical record • Make dangerous abbreviations (and all National Patient Safety Goals) an agenda item at all medical staff department/section meetings • Run articles in physician and employee newsletters about “Do Not Use” abbreviations WWW.ORTODAY.COM

Another approach is having the pharmacy refuse orders that contain prohibited abbreviations. The order must be corrected with the proper abbreviation before the pharmacy processes it.17 Nurses and other healthcare professionals can play a role by notifying the prescribing physician before the order is sent to the pharmacy. The bottom line is to focus on the elimination of prohibited, error-prone abbreviations as a system-wide concern, not one just for healthcare professionals including nurses, pharmacy staff, or physicians. To create a culture of safety regarding abbreviations, hospital and medical staff leadership needs to promote educational efforts, physician “champions” must support the initiative, and clinicians must encourage their peers to adhere to the program. This must be a “physicianowned” process to enforce physician compliance. In 2001, the Joint Commission published Sentinel Event Alert 23: Medication errors related to potentially dangerous abbreviations. In 2002, a National Patient Safety Goal was established to require hospitals to identify and implement dangerous abbreviations; this goal was integrated into the Information Management Standards in 2010.16 During this time, The Joint Commission has stated that the “Do Not Use” abbreviations do not apply to preprogrammed computer systems — effectively stating that if the abbreviation is in the software of the computer program and not entered by the practitioner, then it is not considered a danger or a “Do Not Use” abbreviation.16 The Joint Commission has stated that it will reconsider this decision over time. In the 2017 SAFER Matrix scoring system, The Joint Commission has changed the way in which the survey results are scored.18 In the interest of patient safety, the scoring system weights the score as a high, moderate, or low risk of harm and then it is evaluated by a time frame of occurrence as limited, pattern, or widespread. A facility that has widespread use of “Do Not Use” abbreviations could

fall into an immediate threat for life due to the use of “Do Not Use” abbreviations, negatively affecting the facility’s score.

Situation Critical If you’ve ever watched a movie or a TV show depicting conversations between a pilot and the control tower, you have noticed that when pilots receive instructions, they repeat back to the tower what they heard. The airline industry dealt with accuracy of oral instructions many years ago when it determined that many “near misses” were due to pilots’ misinterpretation of instructions from ground controllers. The healthcare sector now is learning from the airlines. Inaccurate interpretation of critical test results is analogous to the misinterpretation of a ground controller’s instructions: Both can lead to injury and even death. A lack of timeliness in reporting the results of critical tests can be equally devastating. Studies have shown that significant delays often occur in reporting test results that are dangerously abnormal. Prompt treatment for severely elevated or lowered sodium, potassium, or glucose is critical to the patient’s survival.19 To highlight this patient safety issue, The Joint Commission developed two requirements under the communications goal: one related to reading back telephonic reports of critical test results and one related to the timeliness of reporting critical test results to the responsible licensed caregiver.6 The same rules that apply to reading back verbal and telephone orders apply to reading back reports of critical test results. To have hospitals focus on timeliness, The Joint Commission requires them to “measure and assess” the timeliness of reporting critical test results and, if appropriate, take action to improve the timeliness with which the responsible licensed caregiver receives critical test results. Hospitals are now required to have a system that documents the time a critical test result was phoned to and received by a licensed provider. If the test result was phoned to a nursing unit and the nursing APRIL 2019 | OR TODAY |

IN THE OR

continuing education unit then notified the provider, the time between those two actions is also recorded. Clinical administrators then must assess the data and determine whether the times of notification are appropriate, and if not, develop a plan to improve them. The Joint Commission does not prescribe a time frame for reporting; it is up to the organization to determine an acceptable time to get critical test results to a provider who can take action on the results.8,9 The objective of the requirement is to avoid unnecessary delays in treatment. Reporting to an intermediary, such as a physician’s office or a unit nurse, will add more time to the process. However, an analysis of the data will reveal whether reporting to an intermediary is a true delay or whether it is actually a more expeditious way to get the information to the caregiver. To comply with the requirement on reporting critical test results, the organization first must define what constitutes a critical test result, which may come from the laboratory, cardiology, or radiology departments, or from the inpatient, emergency, or ambulatory settings. If an organization fails to define critical test results, surveyors from The Joint Commission will consider all verbal and telephone reports of diagnostic tests to be “critical.”20 A common definition of a critical test result is any value or interpretation for which a delay in reporting can result in serious adverse outcomes for patients. For “critical results” that involve an interpretive component, developing a list of common findings that warrant rapid communication (i.e., “panic values”) may prove useful. Some tests, often known as stat tests, require rapid communication, even if the results are normal.21 Once an organization has defined critical test results, it must address the measurement aspect of The Joint Commission’s recommendation. The organization needs to establish what it expects the reporting time to a licensed provider will be. For stat tests, the reporting time would measure the time from when the test was

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ordered to when the result was reported to the licensed provider. For panic values, the reporting time would be from the time the value was identified to the time it was reported to the licensed provider. When developing a critical test result reporting policy, organizations may want to refer to guidelines from the Massachusetts Coalition for the Prevention of Medical Errors.22 Other resources include a sample policy provided by the ECRI Institute in 2011.23 The sample policy provided by the institute to the National Patient Safety Foundation outlines the steps for developing a policy for reporting of critical test results that are very similar to the 2005 publication by the Massachusetts Coalition for the Prevention of Medical Errors. The basic recommendations from the Massachusetts Coalition for the Prevention of Medical Errors listed below remain applicable today. If anything should be added, it would be to ensure all practitioners read or repeat back the results provided to them by the person reporting them. • Identify to whom the results should go. (That person must be able to take action.) • Identify to whom the results should go if the ordering provider is not available. • Define what test results require timely and reliable communication. • Define the expected time frame for reporting test results to the ordering provider. • Identify how the responsible provider should be notified (direct contact, or through an intermediary). • Ensure that the policy incorporates all types of test results (from radiology, cardiology, pathology, clinical laboratory, etc.). • Design reliability into the system. (Require providers to include their pager numbers when ordering tests, especially critical or stat tests.) • Educate staff and providers to ensure broad knowledge of the critical test result communication policy.22

Another good resource is a Clinical Laboratory News article that addresses the issues with the difficulty in timely reporting of critical values, noting the volume and number of unanswered pages and lack of call backs during times when employees are attempting to report critical values. In the article, the author includes tips for tracking the reporting of critical values in an effort to improve compliance. Some of the tips include making sure the list of critical values is accurate and making the process reliable.24

Your Turn Many communication breakdowns in healthcare occur when one caregiver hands off patient care responsibilities to another.25 Consider this scenario: A patient hospitalized with a thoracic spine injury has to have a routine chest X-ray. The nurse tells the transporter about the patient’s injury and says the patient needs to remain flat and not be logrolled when transferred between beds. When the transporter delivers the patient to radiology, he puts the patient in the holding area because the department is running late. The transporter leaves. When it comes time for the X-ray, the patient is placed in an upright position to maximize the quality of the study. After the X-ray is completed, the patient returns to her room. When the patient’s nurse sees the woman, she is still sitting upright. The nurse lowers the head of the bed and notifies the physician. A neurological exam reveals that the patient cannot move her legs.26 Given the tremendous number of times handoff communication takes place and the opportunities for miscommunication, it’s easy to see why The Joint Commission addressed the issue in its National Patient Safety Goals and has now integrated this goal into the standards.12 It requires that hospitals “implement a standardized approach to handoff communications, including an opportunity to ask and respond to questions.” When handing off a patient, caregivers must provide information to staff members WWW.ORTODAY.COM

the SBAR technique

One way to provide standardized information during handoff is the SBAR technique, which stands for “situation, background, assessment, and recommendation.” SBAR helps the communicator organize his or her thoughts and increases the chances the person listening will understand. Brief definitions for SBAR are:28 • SITUATION: Communicate what is occurring and why the patient is being handed off to another department or unit • BACKGROUND: Explain what led up to the current situation and put it into context if necessary • ASSESSMENT: Give your impression of the problem • RECOMMENDATION: Explain what you would do to correct the problem Putting SBAR into a nursing context — for example, transferring a patient to an ICU from an acute care unit — communication might go like this: “This is Mr. B. He is being transferred because he has been having trouble breathing, and his oxygen saturation continues to decrease [situation]. He was admitted two days ago with COPD and has a history of congestive heart failure and pneumonia. He is being treated with bronchodilators and oxygen [background]. His most recent vital signs were blood pressure 160/100, pulse 110, respirations 30, temperature 99, oxygen saturation 89%. He is experiencing significant dyspnea. Dr. Smith ordered a transfer to the ICU for closer observation and evaluation by an intensivist for possible intubation and ventilatory support [assessment]. He will probably need arterial blood gases, and respiratory therapy staff should be alerted. His family should be notified of his transfer [recommendation].” The receiving nurse now can ask questions to clarify anything he or she didn’t understand. This example of SBAR can be modified to fit the situation, e.g., change-of-shift report or the transfer of a patient to another facility. The most important thing to remember is that any time a handoff occurs, the opportunity for error exists. Effective handoff communication significantly reduces the chance of errors. On September 12, 2017, The Joint Commission published Sentinel Event Alert 58: Inadequate hand-off communication. The alert addresses the fact that inadequate or failed handoffs have been a repeated issue in healthcare. Some suggestions in Sentinel Event Alert 58 refer back to the prior alerts, addressing the role of leadership in developing a safety culture. The alert states that leadership must be committed to adequate and successful handoff as part of patient safety and a safety culture. Sentinel Event Alert 58 also addresses the use of standardized content in all handoffs, completing handoffs without interruptions, and providing standardized training to healthcare workers both in the sending and receiving of handoff communication. As an additional recommendation, the alert suggests reviewing capabilities of technology to assist in accurate handoff. Finally, the facility is challenged to monitor the results of interventions to improve the effectiveness of handoff.10 The hospital can be a safe environment only through staff diligence and awareness of the safety pitfalls that pervade each patient encounter. By understanding the patient safety issues related to verbal and telephone orders, abbreviations and symbols, reporting of critical test results, and handoff communication, healthcare professionals as a team can reduce the likelihood of medical errors and patient injuries. Patients trust that you will protect them in this potentially dangerous environment. Knowing the dangers is your first step!

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continuing education

receiving the patient that reflects the patient’s current condition, treatment, recent changes in condition, and possible changes or complications for which to observe. This must be done in a consistent manner throughout the organization. But the process may be modified based upon the type of handoff, e.g., nursing shift-to-shift report, a patient transferring from the ER, or a patient going to a radiology exam. Handoff can be one of the most dangerous points in any patient’s hospital treatment. The Joint Commission very specifically defines that the opportunity to ask questions of the person providing the handoff should be included in the handoff. Experience with new and different technical tools has given healthcare providers many time-saving tools, one of which is recording a handoff for the other person to listen to. This helps by reducing time that the person who is providing the handoff report has to wait on the phone while the next provider arrives at the phone to listen to the information and ask questions. The key to using new technology and tools safely is to assess them for potential failures or new problems that they may cause. The Joint Commission has required hospitals to complete a proactive risk assessment (previously known as failure mode effects analysis) at least every 18 months.27 A proactive risk assessment is one of the tools that promotes patient safety by having leaders and staff assess potential risks of error or negative consequences, rate the priority of the risks, and then address the process to prevent the risks before the use of a technology or tool.7 While not all negative outcomes may be prevented, the proactive risk assessment greatly reduces the number of errors or variances when using the technology or tool. EDITOR’S NOTE: Charles F. Bombard, MHA, RN, CPHQ, FACHE, the original author of this educational activity, has not had an opportunity to influence the content of this version. OnCourseLearning.com guarantees this educational activity is free from bias. Joyce Lahue, MS, BSN, RN, CPHRM, FASHRM, has 19 years’ experience in risk management and patient advocacy. She is the regional director of risk management for Baptist Health System in San Antonio, Texas, and a past president APRIL 2019 | OR TODAY |

IN THE OR

continuing education and board member of the South Texas Society for Healthcare Risk Management.

References 1. 2018 National Patient Safety Goals. The Joint Commission Web site. https://www.jointcommission.org/standards_information/npsgs.aspx. Accessed May 1, 2018. 2. To Err Is Human: Building a Safer Health System. The National Academies of Sciences, Engineering, and Medicine Web site. https://www. nap.edu/catalog/9728/to-err-is-human-building-a-

safer-health-system. Published 2000. Accessed May 1, 2018. 3. James JT. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf. 2013;9(3):122-128. doi: 10.1097/ PTS.0b013e3182948a69. 4. Human factors analysis in patient safety systems. The Joint Commission Web site. https:// www.jointcommission.org/assets/1/6/HumanFactorsThe_Source.pdf. Published 2015. Accessed May 1, 2018. 5. Facts about the National Patient Safety Goals.

The Joint Commission Web site. https://www. jointcommission.org/facts_about_the_national_patient_safety_goals. Published December 28, 2017. Accessed May 1, 2018. 6. Catalano K. Update on the National Patient Safety Goals—changes for 2005. AORN J. 2005;81(2):335341. doi: 10.1016/S0001-2092(06)60415-8. 7. 2006 National Patient Safety Goals announced. Nursing2005. 2005;35(10):2. 8. Joint Commission National Patient Safety Goals, 2010. VA National Center for Patient Safety Web site. https://www.patientsafety.va.gov/docs/TIPS/

Clinical Vignette Mrs. Anderson, age 70, was admitted to the hospital with uncontrolled diabetes mellitus. Immediately before hospitalization, Mrs. Anderson was seen in her primary care physician’s office, where her blood glucose was found to be 460 mg/dL. The nurse assigned to her care made her comfortable and assessed her. The physician’s orders included a stat blood glucose and regular insulin “100 u/mL, give 1.0 mL.” The stat blood glucose was called back to the nursing unit by the laboratory. The results showed that Mrs. Anderson’s blood glucose level had risen even further, to 613, and a nurse took this information. The nurse did not write down the results or reconfirm the correct value with the laboratory. When the nurse communicated the results to the physician, she transposed the figures and told the physician that the patient’s blood glucose was 361. The physician was satisfied that the blood glucose levels were returning to normal and did not order any further tests. Mrs. Anderson complained of some nausea and abdominal pain, and her physician ordered an abdominal X-ray. She was then taken to the radiology department, but radiology personnel received no information about Mrs. Anderson’s diabetes. The radiology department was very busy, and Mrs. Anderson had to wait for her examination. While she was waiting, her condition deteriorated, and she went into a diabetic coma. 1. How many abbreviation/symbol errors were contained in the physician’s order for insulin? a. One b. Two c. Three d. Four 2. When the nurse received the call from the laboratory with the stat blood glucose results, she should have: a. Done exactly what she did c. Written down the results, preferably in the patient’s chart, and b. Written down the results on whatever material was handy repeated them back to the person providing the results d. Told the laboratory staff member to call the physician with the results 3. When Mrs. Anderson was transferred to the radiology department, pertinent clinical information should have been passed to radiology personnel. This process is known as: a. Verbal transfer b. Handoff communication c. Relational information d. Clinical transfer statement 4. The purpose of communicating essential information when a patient is transferred from one location to another is to: a. Help the patient adapt to new surroundings c. Provide the new staff information so that they don’t have to b. Ensure the receiving staff won’t have to ask questions read the medical record d. Provide pertinent clinical and background information to the receiving staff to ensure patient safety and quality of care

Clinical VignettE ANSWERS 1. Answer: B, There are two unapproved abbreviation/symbol errors: The “u” should be written out as “units,” and “1.0 mL” should not have a trailing “0.” 2. Answer: C, Stat or critical test results are processed in the same way as verbal or telephone orders: written down when received and repeated back to the person providing the information to ensure accuracy. 3. Answer: B, Handoff communication occurs when one caregiver hands off responsibility for a patient to another caregiver. 4. Answer: D, During handoffs, the caregiver receiving the patient needs to have clinical and background information so that the patient receives the appropriate care.

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TIPS_JanFeb10.pdf. Published January/February 2010. Accessed May 1, 2018. 9. 2018 Hospital National Patient Safety Goals. The Joint Commission Web site. https://www.jointcommission.org/assets/1/6/2018_HAP_NPSG_goals_final. pdf. Accessed May 1, 2018. 10. Sentinel event: Sentinel Event Alert 58: Inadequate hand-off communication. The Joint Commission Web site. https://www.jointcommission.org/ sentinel_event.aspx. Published September 11, 2017. Accessed May 1, 2018. 11. Despite technology, verbal orders persist, read back is not widespread, and errors continue. Institute for Safe Medication Practices Web site. https:// www.ismp.org/newsletters/acutecare/showarticle.aspx?id=1167. Published May 18, 2017. Accessed May 1, 2018. 12. 2018 Hospital Accreditation Standards. Oakbrook Terrace, IL: The Joint Commission; 2018. 13. Moghaddasi H, Farahbakhsh M, Zehtab H. Verbal orders in medicine: challenges; problems and solutions. JOJ Nurs Health Care. 2017;1(5). https://juniperpublishers.com/jojnhc/pdf/JOJNHC.MS.ID.555575.pdf. Published May 25, 2017. Accessed March 21, 2018. 14. Cho I, Park H, Choi YJ, Hwang MH, Bates DW. Understanding the nature of medication errors in an ICU with a computerized physician order entry system. PLoS One. 2014;9(12):e114243. doi: 10.1371/journal. pone.0114243. 15. Gaunt MJ. Preventing 10-fold dosage errors. Pharmacy Times Web site. http://www.pharmacytimes.com/publications/issue/2017/july2017/ preventing-10fold-dosage-errors. Published July 27, 2017. Accessed May 1, 2018. 16. Facts about the official “Do Not Use” List of abbreviations. The Joint Commission Web site. https://www.jointcommission.org/facts_about_do_ not_use_list. Published June 9, 2017. Accessed May 1, 2018. 17. Implementation tips for eliminating dangerous abbreviations. University of Washington Web site. http://courses.washington.edu/nutrmgmt/564_ArticlesUsed_07/JCAHO_Implementation%20Tips%20for%20Eliminating%20Dangerous%20Abbreviations.doc. Accessed May 1, 2018. 18. The SAFER Matrix: A New Scoring Methodology. The Joint Commission Web site. https://www.jointcommission.org/safer_matrix_new_scoring_methodology. Published April 29, 2016. Accessed May 1, 2018. 19. Doering TA, Plapp F, Crawford JM. Establishing an evidence base for critical laboratory value thresholds. Am J Clin Pathol. 2014;142(5):617-628. doi: 10.1309/AJCPDI0FYZ4UNWEQ. 20. Williams R. Modified JCAHO Patient Safety Goal for 2004. VA National Center for Patient Safety Web site. https://www.patientsafety.va.gov/ docs/TIPS/TIPS_Dec03.pdf. Published December 2003. Accessed May 1, 2018. 21. Lippi G, Mattiuzzi C. Critical laboratory values communication: summary recommendations from available guidelines. Ann Transl Med. 2016;4(20):400. doi: 10.21037/atm.2016.09.36. 22. Communicating critical test results. Massachusetts Coalition for the Prevention of Medical Errors Web site. http://www.macoalition.org/communicating-critical-test-results.shtml. Accessed May 1, 2018. 23. ECRI Institute. Sample policy: reporting test results. National Patient Safety Foundation Web site. http://c.ymcdn.com/sites/www.npsf.org/resource/ collection/0716DBAD-99BB-460E-9837-1E357423C51C/Sample-Policy.pdf. Published 2011. Accessed May 1, 2018. 24. Malone B. The dilemma surrounding critical value reporting: what does it take to improve communication? American Association for Clinical Chemistry Web site. https://www.aacc.org/publications/cln/articles/2012/december/critical-value-reporting.aspx. Published December 1, 2012. Accessed May 1, 2018. 25. Handoffs and signouts. Agency for Healthcare Research and Quality Web Site. http://psnet.ahrq.gov/primer.aspx?primerID=9. Updated June 2017. Accessed May 1, 2018. 26. Harvey LD. Strengthening handoff communication. Virginia Commonwealth University Web site. https://medschool.vcu.edu/professionalism/lessons_learned/handoff_communication. Updated March 28, 2014. Accessed May 1, 2018. 27. Patient safety systems (PS). The Joint Commission Web site. https:// www.jointcommission.org/assets/1/18/PSC_for_Web.pdf. Published January 2016. Accessed May 1, 2018. 28. SBAR tool: situation-background-assessment-recommendation. Institute for Healthcare Improvement Web site. http://www.ihi.org/resources/Pages/ Tools/SBARToolkit.aspx. Accessed May 1, 2018. WWW.ORTODAY.COM

CE462

How to Earn Continuing Education Credit 1. Read the Continuing Education article. 2. Go online to ce.nurse.com to take the test for $12. If you are an Unlimited CE subscriber, you can take this test at no additional charge. You can sign up for an Unlimited CE membership at https://www.nurse.com/ sign-up for $49.95 per year.

Deadline Courses must be completed by 5/15/2020 3. If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer. 4. Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test. 5. All users must complete the evaluation process to complete course. You will be able to view a certificate on screen and print or save it for your records.

Accredited In support of improving patient care, OnCourse Learning (a Relias LLC company) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. OnCourse Learning is also an approved provider by the Florida Board of Nursing, the District of Columbia Board of Nursing, and the South Carolina Board of Nursing (provider #50-1489). OnCourse Learning’s continuing education courses are accepted by the Georgia Board of Nursing. Relias LLC is approved by the California Board of Registered Nursing, provider # CEP13791.

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Nurse.com You can take this test online or select from the list of courses available. Prices subject to change.

Questions or for a complete listing of our courses Phone: 877-843-8374 Email: nursesupport@relias.com

APRIL 2019 | OR TODAY |

CORPORATE PROFILE soothing scents

MAKING LIFE BETTER F O R PAT I E N T S A N D N U R S E S

oothing Scents Inc. started as a way to help a patient one night after a routine procedure. Since that evening, Nurse Anesthetist Wendy Nichols, CRNA, APRN, BSN, has seen the company grow and expand its offerings. OR Today interviewed the Soothing Scents co-founder, who also serves as its director of creative development, to find out more about the company and what it has to offer health care providers and patients.

48 | OR TODAY | APRIL 2019

Q: CAN YOU SHARE A LITTLE BIT ABOUT YOUR COMPANYâ&#x20AC;&#x2122;S HISTORY AND HOW IT ACHIEVES SUCCESS?

Nichols: Late one night, after doing anesthesia for a C-Section, I decided to investigate the use of essential oil vapor to help my nauseated patients. It is a common practice to have patients inhale isopropyl alcohol vapor when they experience nausea, but I thought because essential oils were high in natural alcohols that they might have an even better effect, while smelling signifi-

cantly better. This led to over a year of research and development. My brother, Roy, and I started the company Soothing Scents to manufacture and distribute our first product QueaseEASE, which is an inhaler delivery system that uses a blend of four essential oil vapors to help manage postoperative nausea. So, what began with me ordering little aluminum tins off the Internet and assembling QueaseEASE kits on my kitchen table, solely to help the patients in our little rural Maine hospital, has now expanded to a state-of-the-art facility serving over WWW.ORTODAY.COM

SPONSORED EDITORIAL

CORPORATE PROFILE soothing scents

1,500 health care facilities, and we’re growing every day. We achieve success purely because there is a need, which we were passionate about filling (and because Roy is a brilliant entrepreneur). Q: WHAT ARE SOME ADVANTAGES THAT YOUR COMPANY HAS OVER THE COMPETITION?

Nichols: As the first company to develop therapeutic inhaled essential oil (TIEO) solutions for the health care environment, our advantage is that we have a thorough understanding of the safety features that are required – particularly with regards to perioperative patients who may be drowsy from anesthesia and thus require a higher standard of monitoring and vigilance. Our products have been developed by health care providers, are all evidence based and have been clinically validated through multiple independent studies. Q: WHAT ARE SOME CHALLENGES THE COMPANY FACED LAST YEAR? HOW WERE YOU ABLE TO OVERCOME THEM?

Nichols: For many years, we were the only TIEO product in health care, although last year saw a few cheaper priced competitors join the field. Fortunately our nurse champions recognize the value of our delivery systems – which are designed specifically for patient safety – and our commitment to

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using only the highest quality, evidencebased essential oil blends. So, in that way, our focus on safety and validated research very much sets us apart. Q: CAN YOU EXPLAIN YOUR COMPANY’S CORE COMPETENCIES AND UNIQUE SELLING POINTS?

Nichols: Our core competency is that, as health care professionals ourselves, we understand the issues that exist in the clinical area. We offer a bridge between complementary and traditional health care by providing essential oil therapy in a format that has scientific backing and adheres to specific safety standards. We are also building a focus on educating nurses in essential oil best practices and adding to the body of clinically validated knowledge of essential oil use in the health care setting. Q: WHAT PRODUCT OR SERVICE THAT YOUR COMPANY OFFERS ARE YOU MOST EXCITED ABOUT RIGHT NOW?

Nichols: We have a few new projects that we are quite excited about. First, we are launching a new blend, CLEAR, that soothes nasal congestion. Our initial test results are quite good, and I think it will be very helpful for seasonal allergy sufferers. Secondly, we are developing a consulting service for hospitals that will help streamline the integration

of TIEO into their facility. Third, we are creating a very well-rounded educational seminar for health care professionals interested in learning more about evidence-based integrative therapies. Q: WHAT IS ON THE HORIZON FOR YOUR COMPANY? HOW WILL IT EVOLVE IN THE COMING YEARS?

Nichols: We foresee TIEO becoming a standard first-line treatment for nausea and anxiety throughout the hospital, including areas such as labor and delivery and emergency departments. We will continue to support nursing education and research, while continuously offering innovative nondrug solutions for patient well-being.

Q: CAN YOU SHARE SOME COMPANY SUCCESS STORIES WITH OUR READERS – A TIME THAT YOU “SAVED THE DAY” FOR A CUSTOMER?

Nichols: One of our favorite things at Soothing Scents is to read the wonderful comments sent to us from our customers. We have had thousands over the years, but the ones that really stand out are from patients going through difficult situations such as chemotherapy. We are humbled and touched when they take the time to let us know how much our products helped them.

APRIL 2019 | OR TODAY |

CORPORATE PROFILE soothing scents

Wendy Nichols, CRNA Creator of QueaseEASE Q: CAN YOU PLEASE DESCRIBE YOUR COMPANY’S FACILITY?

Nichols: We are incredibly proud of our facility in Newton, Alabama, which has over 5,000 square feet specifically designed to manufacture our type of product. It is a light-filled, happy space that sets standards for best manufacturing practices. Our employees love it, and that makes us very happy. Q: CAN YOU HIGHLIGHT ANY RECENT CHANGES TO YOUR COMPANY?

Nichols: We are always innovating and looking for ways to improve our products and customer experiences. In 2018, we were able to move most of our production in-house, which has resulted in higher quality and lower costs that we can pass on to customers. Q: CAN YOU TELL ME ABOUT YOUR EMPLOYEES?

Nichols: Our employees are really the best, and we’re so grateful for their kindness, excellence and passion. The heart and soul of our company has to be Kurt Waid, our operations manager. His unfailing positive attitude has contributed greatly to our success. Q: WHAT IS YOUR COMPANY’S MISSION STATEMENT, OR IF YOU DON’T HAVE A SPECIFIC ONE, WHAT IS MOST IMPORTANT TO YOU ABOUT THE WAY YOU DO BUSINESS?

Nichols: Our mission is to develop safe and effective nursing interventions that provide innovative solutions for the requirements of the modern medical environment. The most important thing for us, and in the way that we do business, is to always delight our customers, make sure our products set the standard for safety and ease of use, and to provide science-backed evidence for each and every claim we make.

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Q: IS THERE ANYTHING ELSE YOU WANT READERS TO KNOW ABOUT YOUR COMPANY?

Nichols: Our company was started with the desire to provide health care professionals with a way to ease patient suffering safely and simply. We organize around that founding principle by simply providing the best essential oil delivery systems for patient use, investing in educational opportunities and supporting clinical research. In closing, Soothing Scents is a different kind of medical product company, dedicated to building a science-informed bridge between conventional and alternative medicine through evidence-based essential oil solutions, delivery innovation and nursing education. Its mission originated from a question about a problem it was looking to solve: How can patient suffering be effectively relieved without using medication? This led to more questions: What would it take to bridge the gap between complementary and conventional medicine? What would a company that does this look like? And how could the founders rethink nursing interventions to address the current issues facing patients, nurses and facilities? So, through extensive scientific research and discussions with hundreds of medical professionals, Soothing Scents created a range of drug-free, essential oil-based based products designed specifically to combat perioperative nausea and anxiety, provided in innovative delivery systems that allow nurses and patients to manage these symptoms immediately, anytime and anywhere. The products origins are 100 percent medical, the ingredients are 100 percent natural, and the company’s aim is to create modern solutions that enhance the recovery of patients and the quality of care provided by nurses across the country. For more information, contact the company at info@soothing-scents.com or visit soothing-scents.com.

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HIGH DEMAND By Don Sadler

54 | OR TODAY | APRIL 2019

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he low national unemployment numbers are forcing many businesses to scramble to find well-qualified, high-quality employees. Hospitals and health care organizations are facing employment challenges of their own – especially when it comes to hiring and retaining qualified perioperative nurses.

Shortage is Getting Serious “The OR nursing shortage is becoming increasingly more serious as baby boomers continue to retire,” says Donna Doyle, DNP, RN, CNOR, NE-BC, senior advisor, surgical services, with OhioHealth Grant Medical Center. This shortage is contributing to a host of problems in the OR, says Zee Barreras, BSN, RN, CNOR, surgical services clinical educator with Tucson Medical Center. “These include staff burnout, low morale, and dysfunctional and inadequate patient care,” she says. About a quarter of the perioperative staff where Barreras works will be retiring over the next five to seven years, she notes. Susan Becia, career center manager with the Association of periOperative Registered Nurses (AORN), runs down her own list of problems that the OR nursing shortage can lead to. “Stress, burnout, and mental and physical fatigue are all results of nursing professionals working under less-than-optimal staffing conditions,” she says. One of the less-obvious dangers of the OR nursing shortage is the “brain drain” that occurs when experienced nurses retire, adds Becia. “They take their wealth of knowledge with them, which isn’t easily replicated when novice nurses are hired to replace them,” she explains. “The loss of critical thinking of retiring OR nurses with more than 20 years of experience will negatively impact the quality of patient care,” adds

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Doyle. “Mentorship of novice nurses may be impacted as well.”

Eye-Opening Statistics The statistics with regard to the overall nursing shortage are eye-opening. For example, the Bureau of Labor Statistics predicts a shortage of more than one million nurses in the U.S. by 2022. And more than 438,000 new RN jobs are expected to be added to the U.S. workforce between now and 2026.

they believe the nursing shortage has had a moderate-to-crisis effect on their working environment. The top reasons for the OR nursing shortage cited by survey participants were insufficient compensation and benefits (listed by 43 percent of respondents), employees leaving the facility or industry (42 percent), a lack of qualified and experienced perioperative nurses (41 percent), too heavy of a workload (36 percent), nurse re-

“ The OR nursing shortage is becoming increasingly more serious as baby boomers continue to retire.” Donna Doyle But the nursing shortage is even more severe in the operating room. This is due to several factors, including the fact that perioperative nurses are older on average than nurses in other specialties. For example, Doyle cites research indicating that the average age of perioperative nurses is between 51 and 55, while the average age of nurses in other specialties is between 42 and 47. “Many organizations are not aware of their own demographics related to the age ranges of their perioperative nurses and their plans for retirement,” she says. The 2018 AORN Salary and Compensation Survey determined that the median percentage of vacant full-time perioperative nursing positions has more than doubled in five years. The 2018 survey determined that the median percentage of vacant full-time perioperative nursing positions is 7.1 percent, up from just 3 percent in 2013. Also, six out of 10 (63% ) perioperative managers said they have at least one open position, and 67% said

tirements (34 percent) and job-related stress (31 percent). In particular, Barreras has witnessed the impact of high stress levels and the demands of call on OR nurse attrition. “Most nurses can tell you about the ‘emergent tubal’ they have been called in for,” she quips. “Hospitals have failed to be creative when it comes to staffing and many nurses are unwilling to sacrifice family time for their jobs,” she adds. “No amount of overtime can ever buy back lost time with your family.”

Perioperative Challenges One reason why the nursing shortage is especially challenging in the perioperative environment is the time and cost required to train new OR nurses. “Working in the OR requires lengthy additional training, regardless of the education a nurse has,” says Barreras. “The skills needed to work successfully in the OR are not taught in the typical nursing academic curriculum.”

APRIL 2019 | OR TODAY |

“ This ultimately impacts the quality of patient care that’s delivered and contributes to high stafF turnover.” Zee Barreras Doyle agrees. “There’s an absence of perioperative curriculum in undergraduate nursing education,” she says. “This prevents student nurses from the imprinting that comes with exposure to the OR. “Nursing students are unfamiliar with the importance of the perioperative nurse’s role in caring for patients who are at the most vulnerable time in their health care experience,” Doyle adds. Barreras believes it’s crucial for hospitals to invest in and institute Periop 101, AORN’s blended educational program for perioperative nurses that’s now in use in more than 2,500 hospitals and ASCs nationwide. “This program is one of the best resources for training and retaining competent perioperative staff,” she says. “Personally, I would like to see hospitals and schools work together in providing the Periop 101 course,” Barreras adds. “The didactics of the course could be taught in the classroom and a clinical experience provided to teach hands-on skills in the OR.”

Potential Solutions So what are some possible solutions to the OR nursing shortage? Doyle believes that solving the problem starts with knowing the demographics at your own organization. “Based on this information, develop a plan to prevent catastrophic staff shortages that may impact your ability to meet patients’ surgical needs. “Also work with your human resources department to make sure

56 | OR TODAY | APRIL 2019

there is a good recruitment plan that’s specific to the OR,” Doyle adds. “And partner with academic nursing programs to develop or teach a nursing perioperative elective.” Barreras urges hospitals not to give in to the temptation of hiring “warm bodies” to fill open perioperative positions. “This ultimately impacts the quality of patient care that’s delivered and contributes to high staff turnover,” she says. Doyle would also like to see hospitals present information sessions to high school students who may be interested in a career in perioperative nursing. Betsy Vane, RN, MSN, CNOR, CRCST, CHL, CSPDT, a health science teacher at Health Careers High School in San Antonio, Texas, says that a half-dozen of her students have expressed interest in pursuing careers in perioperative nursing. “Hospitals could partner with high schools and schools of nursing to provide real-life perioperative nursing experiences for students,” says Vane. “High schools could then offer off-campus rotations that specifically target perioperative nursing skills.” Vane believes that we need to engage the next generation of health care providers by “advertising what a career in perioperative nursing can do for them. For example, let’s take the exciting opportunities that perioperative nursing offers out from ‘behind the red line’ and give students exposure to the real-life adventures they can have as perioperative nurses.”

The Role of Succession Planning

“it’s important for perioperative executives to understand the importance of succession planning and start taking steps now to plan for the future of their departments.” Susan Becia

lenges of the OR nursing shortage. “Succession planning is critical to ensuring a culture of growth in the OR,” says Doyle. “The commitment to succession planning must be present throughout the organization, since it takes a certain amount of time and money.” “A lack of succession planning increases the likelihood that someone without the necessary training, experience and leadership skills will be hired to fill open executive positions,” says Becia. “Therefore, it’s important for perioperative executives to understand the importance of succession planning and start taking steps now to plan for the future of their departments.”

Of course, succession planning also plays a big role in meeting the chal-

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SPOTLIGHT ON

Susan Mastrangelo BSN, RN, CNOR

• BY MATT SKOUFALOS •

s an operating room nurse, Susan Mastrangelo is quite familiar with the process of harvesting donor organs. At Lourdes Medical Center of Burlington County in Willingboro, New Jersey, where she works, doctors partner closely with the nonprofit Gift of Life to find suitable matches for patients awaiting a transplant. But in Mastrangelo’s experience, and that of many of her colleagues, “all we see is the organs taken away,” she said. “We never know where they’re going to end up, or the process on the other end.” This winter, however, Mastrangelo got a first-hand glimpse into the other side of things as her daughter, Danielle, underwent a double lung transplant to correct complications from cystic fibrosis. Diagnosed with the disease at birth, Danielle received followup care at Children’s Hospital of Philadelphia (CHOP) throughout her childhood, and was transitioned over to the University of Pennsylvania Hospital as an adult. In recent years, doctors had been pushing for the 28-year-old to undergo a lung transplant, and the birth of her own daughter two years ago accelerated that timeline. “They worked her up in June 2018, and she was on the transplant list for a month,” Mastrangelo said.

58 | OR TODAY | APRIL 2019

“If this family had not signed up to donate their member’s organs, I don't know where my daughter would be.” There was one false start to the process – surgeons passed on a pair of lungs that had been identified as a likely match for Danielle – but a week later, they found a set they felt was the right fit. She went into the hospital December 12, had the surgery January 5, and by midFebruary, was home, ready to return to her regular routine. “It’s amazing,” Mastrangelo said. “[As nurses], all we see are the organs; [this time], I actually got to see where they went and how it affected so many lives.” Danielle, who had been accustomed to breathing with continuous oxygen, had to learn how to do so independently. With the help of the respiratory therapists, physicians, and the nurse practitioners who cared for her, she’s made rapid progress, Mastrangelo said.

“It’s amazing,” her mother said. “She’s doing fantastic. She’s up walking around, not using [supplementary] oxygen. She’s living a normal life that she has not had for five years.” Mastrangelo is used to caring for people. She entered the nursing profession 35 years ago, when her father was ill with a rare disease. The care and compassion with which his nurses handled him touched her, and it didn’t hurt to have a sister, cousin, and niece who all are in the profession as well. “I like to help people, and I don’t have the patience to be a teacher,” Mastrangelo said. “Once I started, I really found out this is what I loved. I can’t imagine doing anything else.” Nursing was a different career entirely in 1984; one far less technology-oriented with a focus on bedside care. Mastrangelo earned her associate’s degree at Mercer Medical Center in Trenton, New Jersey, later completed a critical care certificate, and landed in the ICU for 15 years. About 10 years ago, Mastrangelo was invited to rotate into the OR, and agreed that it was time for a change. The duties were totally different from what she’d done before, and Mastrangelo found

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Susan Mastrangelo (center/fourth from right in the foreground) is seen with her colleagues at the Lourdes Medical Center of Burlington County in Willingboro, New Jersey.

the switch-up was a welcome one. Five years later, she completed a bachelor’s degree and earned her CNOR certification. “With what nurses do, I think it’s important that they switch,” Mastrangelo said. “The priorities are different now; there just isn’t the staff ability to do the things we used to do at bedside. Patients are sicker, requiring more nurses sometimes, and there just isn’t the amount of nurses that there used to be.” There was a national nursing shortage when Mastrangelo was in nursing school, and another is anticipated within the next few years. Switching concentrations is another way of filling in gaps, while also assuring career longevity for nurses who might be in danger of suffering from burnout. What Mastrangelo was most impressed by was the team dynamic of the OR. It’s not only a key aspect of the day-to-day responsibilities of her job, but one that was reinforced when it was time to care for Danielle. “This OR group is incredible,” she said. “We could not have done what we did [for my daughter] without the support of the people here. They picked up my shifts; I spoke to my

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supervisor, and everything was taken care of until I was ready to get back to work.” “I would do the same for somebody else,” Mastrangelo said. “It’s totally a team effort. They had to work a little harder, and my daughter wouldn’t be here if they didn’t do that. I would have had to worry about being here or lose my job, and I didn’t.” As a career, Mastrangelo is very satisfied with her chosen profession. The work is “by no means easy,” but rewarding in novel and persistent ways. “It’s a good, fulfilling job to have,” she said, “but you have to have a certain mentality for it too. You have to realize every patient’s different. You have to work as a team.” By supporting her when she needed it most, Mastrangelo’s team gave her a freedom from worry. With her daughter gaining independence and in good health, Mastrangelo is now able to focus more on her granddaughter, Carson – and maybe develop some hobbies. “I’m going to have to get something to do now that I don’t have to take care of my daughter anymore,” she laughed. “Maybe I’ll take up golf.”

Susan Mastrangelo (right, standing), her daughter Danielle, granddaughter Carson, and “Elsa” celebrating Carson’s third birthday.

Would you like to nominate someone for the spotlight article? Visit ortoday.com/nominations/

APRIL 2019 | OR TODAY |

OUT OF THE OR fitness

When to Change Your Routine By Miguel J. Ortiz o, you’ve dropped a couple of pounds but your starting to plateau. You keep the same diet, if you cheat its accounted for, and you have been crushing it in the gym.

Chances are that because of your consistency you have come a long way so don’t get discouraged. If anything, look at this as a compliment to your hard work. If you’re stuck at a certain weight or body fat measurement it’s because the combination of your diet, exercise and sleep have been able to maintain that metabolism. So, before you make any changes be proud of getting to this point and let’s do some reflection on what your program has been consisting of, making changes too soon without looking at previous behaviors could have you moving in the wrong direction. The first thing you absolutely need to look at is getting more sleep. If sleep has been lacking then changing some routines to add more stretching, getting a massage or adding more foam rolling could all be helpful to aid in recovery. Which is exactly what sleeping is for, to recover. Every program – whether

60 | OR TODAY | APRIL 2019

weight loss, strength or muscle building – requires quality recovery. So, make sure you are recovering well from exercise and your day-to-day work activities. Next, let’s take a brief look at exercise. We don’t want to over think it. It could be as simple as adding another day to your program like a yoga class, Pilates, HIIT training or changing little variables like sets and reps. Keep in mind that adding more exercise can be helpful, but make sure you’re not over doing it. This extra day can challenge you, but it must compliment your goals and your current routine. For example, if you’re doing lots of yoga and want to start doing more weight training. then adding in one day a week of strictly strength training can be very helpful as you increase training days. If you’re doing a lot of strength training and need to add some stretching, then adding one day of yoga can be helpful. All training routines need to have a quality warm up, training routine, cool down/ recovery and quality fuel. When to change your diet isn’t always the easiest thing to determine. There are many different diets to try and that can lead to more confusion. If you’re not talking to a dietician or

health professional, the only thing I personally would focus on is if you’re getting enough fiber? You can personally never go wrong with more greens. Maybe your metabolism needs a little boost. Try cutting out unnecessary sugars or processed foods, drink only water, avoid alcohol and consume appropriate portion sizes. Take your time and be sure that when changing your diet that you are making small changes and know that you might need to try something for more than a week or two before you see any change. Keep your head up, be patient and enjoy the process as you learn about your body. And, always have fun! Miguel J. Ortiz is a personal trainer in Atlanta, Georgia. He is a member of the National Personal Trainer Institute and a Certified Nutritional Consultant with more than a decade of professional experience. He can be found on Instagram at @migueljortiz.

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OUT OF THE OR health

‘Cramps’ Rhymes With ‘Stamps’; Here’s How to Lick ‘Em By Marilynn Preston

lass is in session. Today’s topic isn’t the sexiest, but if you’ve ever had a muscle cramp during sex, you know how it can snap the brain to complete attention. Cramps happen at other times, too. You’re running across a tennis court when suddenly, someone is jabbing a fork into your calf. Or you’re blissfully swimming along and for no reason, your toes get stuck in a vise. Or you’re asleep in bed hours after a vigorous walk – nighttime cramps are very common – and you’re jolted awake with a piercing pain in your thigh. So much for the problem. Let’s talk solutions. Though it’s still a bit of a mystery why some people get cramps – aka charley horses or muscle spasms – there are lots of things you can do for prevention and relief. Let’s begin with a little basic physiology.

62 | OR TODAY | APRIL 2019

CRAMPS R US

OTHER CAUSES

Every movement you make involves the contraction and relaxation of a muscle. When your muscle contracts (gets shorter), there is a change in the concentration of sodium and potassium ions (minerals called electrolytes) inside the muscle. When your muscle relaxes, the concentration of sodium and potassium goes back to normal. At least, that’s the cosmic plan. But if you work your muscles too hard or too long (overexertion) or if you don’t drink enough fluids (dehydration), you may cause the ionic concentration to get so out of balance that your muscle contracts – and stays contracted. The result? A cramp! Sometimes, the muscle will cramp right away, while other times, it has a delayed reaction and cramps up later at night. It might last a minute or less, or it may really take hold and hang on, so much so that you actually feel muscle soreness the next day.

High heels, a sedentary lifestyle and circulation problems can bring on cramps, and so might certain medications (statin drugs, for instance). A change in terrain that puts more strain on your muscles – climbing hills versus walking the flats – can also cause leg cramps. So exercise your curiosity: What might be causing your cramps? Figure it out; the solution is often simple. In some cases – when reoccurring cramps are accompanied by swelling or muscle weakness – the problem could involve a malfunctioning vascular system – and for that, you’ll have to consult a doctor.

SELF-MASSAGE WORKS There’s a good chance you can relieve your cramp by calmly, gently massaging and stretching the cramping muscle. This is hard to manage when you’re writhing in pain, so try a few deep-relaxing breaths at the first sign of trouble. Let’s say it’s your calf that’s WWW.ORTODAY.COM

OUT OF THE OR health

When Quality Matters

cramping. While you’re massaging the stricken area, flex your foot so your toes are pointing back toward your knees. (This contracts the muscle in front of your shin and relaxes your calf.)

WARM UP Warming up your muscles before you work out and stretching afterward can help prevent cramping. But do it like you mean it, with a focus on relieving muscle tension and fatigue and keeping your body fluids flowing to flush away waste products. If you’re plagued by night cramps, try some gentle stretching before you go to bed.

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SLEEP IN SOCKS Sleeping with socks on has helped me, and it might help you. Don’t go to sleep with your toes pointed. And though this is tough to monitor when you’re in dreamland, it helps to sleep on your side. Also, sleeping with tight blankets or sheets can bend your toes down and trigger cramps.

STAY HYDRATED This is a biggie. To avoid dehydration and cramping, drink, drink, drink enough fluids to keep your urine clear. A glass of water before bedtime can help, too.

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GET YOUR MINERALS Sometimes, cramps happen because you’re lacking minerals. A small can of tomato juice gives you a quick jolt of potassium, and so do bananas. Magnesium and calcium supplements can also help. Personally, I get good results from a magnesium product called Calm. As always, no single remedy works for everyone. You have to experiment and see what works for you. This is true for everything in life. – Marilynn Preston is the author of “Energy Express,” America’s longest-running healthy lifestyle column. For more on personal well-being, visit www.MarilynnPreston.com.

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APRIL 2019 | OR TODAY |

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Changing the face of patient safety

OUT OF THE OR EQ Factor

Employees are Like Diamonds By Daniel Bobinski f you think about it, your fellow employees are like diamonds. Each has many facets, each one is valuable and the best ones are highly sought after. There’s also something else we should note in our comparison. If we’re smart, we look past their flaws.

Like diamonds, every employee is exceptionally unique. If you want to help build a strong team, one thing you can do is discover each employee’s uniqueness and capitalize on what you find. After all, you can choose to look at what’s valuable or you can look at the flaws. To build a productive, effective, and profitable workplace, it helps to think of everyone as diamonds and focus on what is good. Ask any jeweler, and they’ll tell you that it’s the cut of a diamond – the facets – that provide its beauty. When I teach emotional intelligence, I often refer to the different aspects of one’s personality as “facets,” and I put the facets in three distinct groups, which I call head, hands and heart. “Head” refers to a person’s cognitive style. “Hands” relates to behavioral preferences, and “heart” has to do with motivation – that which is often associated with attitudes and values. WWW.ORTODAY.COM

Understanding the “head” facets allows us to differentiate among cognitive styles. This includes the different ways people perceive information, how they process that information and how they make decisions. The head facets also include the different ways people get mentally re-energized. People have different preferences in these areas, and there are pros and cons to each. However, if we want our team to shine, we need to focus on strengths, not flaws. As a side note, the Myers-Briggs Type Indicator is a cognitive styles assessment that can be used to help understand these facets. The set of facets for “hands” is about behavioral styles. Again, we should be focusing on strengths, not weaknesses. If you’re familiar with DISC assessments or the Four Temperaments (driver, expressive, amiable and analytic), you already know about these facets. Some people place a high value on getting results whereas others are more interactive and outgoing. Some are loyal and steady, working quietly behind the scenes, and still others strive to be accurate and precise. Everyone has a blend of these tendencies, but almost everyone has a strong preference toward one or two of these styles. Lastly are the motivators, or “heart”

facets. These include attitudes about learning, about money and how people prefer their surroundings to be. Heart facets also include the different ways people help others, their preferences about being in charge (or not), and the systems people use for living their lives. An assessment tool called “Driving Forces” helps identify one’s motivational preferences. When practicing emotional intelligence, it’s important to see the value in all the different facets, even the ones that are different from ours. The other choice is criticizing the flaws, but that does nothing for building a cohesive team. Bottom line, we help our teams shine when we focus on the strengths of each team member. Daniel Bobinski, M.Ed. teaches teams and individuals how to use Emotional Intelligence, and his videos and blogs on that topic appear regularly at www.eqfactor.net. He’s also a best-selling author and a popular speaker at conferences and retreats. Reach him at daniel@ eqfactor.net or 208-375-7606.

APRIL 2019 | OR TODAY |

OUT OF THE OR nutrition

Bring on the Spice By Nicole Wavra, M.P.H., R.D. e all know the importance of herbs and spices for enhancing the flavors in our foods, but do you know how herbs and spices can enhance your health as well? They have been used for centuries for culinary and medicinal purposes. Herbs like basil, oregano and cilantro are the leaves of the plant, and spices like coriander, cinnamon, and ginger come from the roots, bark, berries, flowers or seeds of the plant.

Cinnamon Cinnamon is made from the dried and then ground bark of a tree native to Sri Lanka. It contains one of the highest levels of antioxidants compared with other common spices. Research shows that consuming cinnamon may help lower blood sugar levels by slowing the breakdown of carbohydrates in the digestive track and by improving insulin sensitivity. Additionally, it has been shown to significantly decrease fasting blood sugars.

Turmeric

Rosemary

Turmeric is a spice that has been used for centuries especially in the Indian culture for culinary, medicinal, traditional and religious purposes. Turmeric’s vibrant golden hue comes from a substance known as curcumin. Curcumin is also what makes turmeric a medicinal “cure-all,” – thought to aid in oxidative damage, inflammation, brain function, Alzheimer’s disease, heart disease, cancer, arthritis and depression. Curcumin fights free radicals in two ways: It blocks free radicals and it also helps to increase our body’s own antioxidant enzymes. Curcumin has such strong anti-inflammatory properties that it matches the power of some anti-inflammatory drugs but without the side effects.

Read this while eating rosemary and you will most likely remember more of the content due to the positive effect rosemary has on our brain and memory. Studies show that even just smelling rosemary can enhance brain function and memory. In one small study rosemary was also beneficial for reducing allergy symptoms and nasal congestion.

Ginger Ginger is a spice native to Asia and is closely related to turmeric. It is most effective at reducing nausea and vomiting due to sea sickness, chemotherapy and pregnancy. Ginger helps the digestive system by relieving flatulence and by relaxing and soothing the intestinal tract.

Garlic Garlic is part of the onion family, also known as the Allium family. Hippocrates prescribed garlic for many medicinal purposes. Today we know that garlic supplements can boost immune function and can help to avoid and to shorten the duration of a cold or flu. Garlic supplements can also help to reduce blood pressure and cholesterol. Reprinted with permission from Environmental Nutrition, a monthly publication of Belvoir Media Group LLC.

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OUT OF THE OR

Recipe

recipe

the

68 | OR TODAY | APRIL 2019

Chicken Enchiladas INGREDIENTS: • Cooking spray • 1 (15-ounce) can enchilada sauce • 1 (4-ounce) can diced green chiles (do not drain) • 4 cups shredded, cooked chicken (from a 3- to 4 -pound roasted chicken) • 1 (15-ounce) can black beans, drained • 3 1/2 cups shredded Mexican cheese blend, divided • 1/4 cup fresh cilantro leaves, chopped and divided • 8 (10-inch) large flour tortillas

Meghan Splawn is associate food editor for TheKitchn.com, a nationally known blog for people who love food and home cooking. Submit any comments or questions to editorial@thekitchn.com.

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Easiest Enchiladas

OUT OF THE OR recipe

You’ll Ever Make aking enchiladas is my favorite way to transform leftovers into an easy, flavorful dinner. Tender roasted chicken gets dressed up with spicy, piquant enchilada sauce, covered in shredded cheese, then wrapped in tender tortillas and baked until warm. What’s not to love? On nights when you need the cozy comfort of enchiladas ASAP (and isn’t that most nights?), this 30-minute version is here for you. While the recipe relies on shortcut ingredients, the resulting enchiladas certainly aren’t short on flavor or satisfaction. 4 key steps for the best chicken enchiladas 1. Use rotisserie chicken. You can totally roast your own chicken for enchiladas, but grabbing a rotisserie chicken from the deli at the supermarket will save you a lot of time. Ultimately, you won’t be able to tell the difference, thanks to the flavor and moisture you’ll add when you toss together the filling. 2. Amp up the flavor with canned chiles. Speaking of the filling, we’re adding a can of diced green chiles to the enchilada sauce to boost its flavor and increase its yield. No need to measure anything here – just stir together

an entire 15-ounce can of sauce and 4-ounce can of chiles. 3. Add sauce three ways. You’ll add some of the sauce to the bottom of the casserole dish, stir some into the filling, and pour the rest all over the enchiladas in the pan. This will ensure that the enchiladas reach creamy, tender perfection. 4. Roll, scooch, repeat. To assemble the enchiladas, you’ll fill each tortilla with about 1/2 cup of filling and roll to close. Place seam side down in the pan, scooch it over, and repeat. The tortillas will need to be nice and snug for all of them to fit.

Make-ahead and serving options You can assemble this casserole a day in advance or freeze for future baking – just be sure to bring it to room temperature before baking. You’ll know it’s done when the sauce is bubbling, the cheese is melted and browned, and the ends of the tortillas are nice and crisp. As for serving, a flurry of fresh cilantro and a dollop of sour cream are just about all this easy casserole needs.

Chicken Enchiladas Serves 4 to 8 1. 2. 3.

5. 6. 7.

Arrange a rack in the middle of the oven and heat to 400 F. Coat a 9-by-13-inch baking dish with cooking spray. Stir the enchilada sauce and the green chiles and their liquid together in a small bowl. Transfer 1 cup of this sauce into the bottom of the baking dish; set aside. Place the chicken, black beans, 2 cups of the shredded cheese, 1/2 cup of the enchilada sauce mixture, and 2 tablespoons of the cilantro in a medium bowl. Use tongs to toss the mixture and coat the chicken and cheese with the sauce. Working with one tortilla at a time, arrange 3/4 cup of the filling down the center of the tortilla. Wrap the tortilla tightly around the filling and move the tortilla seam side down to the baking dish, tucking the ends of the tortillas underneath to close the ends. As you continue to add filled tortillas to the pan push the filled tortillas together to create a tight casserole. Top the filled enchiladas with the remaining enchilada sauce mixture (you’ll have about 3/4 cup). Sprinkle with the remaining 1 1/2 cups of cheese. Bake until the enchilada sauce is bubbly and the cheese is melted and just beginning to brown, 20 to 25 minutes. Cool the enchiladas for 5 minutes before sprinkling the remaining cilantro on top and serving. Recipe notes: Leftovers can be refrigerated in an airtight container for up to four days.

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APRIL 2019 | OR TODAY |

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that Caught Our Eye This Month

OUT OF THE OR pinboard

Ways to Boost Energy Get plenty of sleep Research suggests that healthy sleep can increase ATP levels. ATP levels surge in the initial hours of sleep, especially in key brain regions that are active during waking hours. Talk with your doctor if you have problems sleeping through the night.

hen I’m dragging and feeling tired during the occasional low-energy day, my go-to elixir is an extra cup (or two or three) of black French press coffee. It gives my body and brain a needed jolt, but it may not help where I need it the most: my cells. What we call “energy” is actually a molecule called adenosine triphosphate (ATP), produced by tiny cellular structures called mitochondria. ATP’s job is to store energy and then deliver that energy to cells in other parts of the body. However, as you grow older, your body has fewer mitochondria. “If you feel you don’t have enough energy, it can be because your body has problems producing enough ATP and thus providing cells with enough energy,” says Anthony Komaroff, M.D., professor of medicine at Harvard Medical School. You may not be able to overcome all aspects of age-related energy loss, but there are ways to help your body produce more ATP and replenish dwindling energy levels. The most common strategies revolve around three basic concepts: diet, exercise and sleep.

turkey, fatty fish like salmon and tuna, and nuts. While eating large amounts can feed your body more material for ATP, it also increases your risk for weight gain, which can lower energy levels. “The excess pounds mean your body has to work harder to move, so you use up more ATP,” says Komaroff. When lack of energy is an issue, it’s better to eat small meals and snacks every few hours than three large meals a day, according to Komaroff. “Your brain has very few energy reserves of its own and needs a steady supply of nutrients,” he says. “Also, large meals cause insulin levels to spike, which then drops your blood sugar rapidly, causing the sensation of fatigue.”

Stick to an exercise routine Exercise can boost energy levels by raising energy-promoting neurotransmitters in the brain, such as dopamine, norepinephrine and serotonin, which is why you feel so good after a workout. Exercise also makes muscles stronger and more efficient, so they need less energy, and therefore conserve ATP. It doesn’t really matter what kind of exercise you do, but consistency is key. Some research has suggested that as little as 20 minutes of low-to-moderate aerobic activity, three days a week, can help sedentary people feel more energized. When being tired warrants a visit to your doctor You should see your doctor if you experience a prolonged bout of low energy, as it can be an early warning of a serious illness. “Unusual fatigue is often the first major red flag that something is wrong,” says Komaroff. Lack of energy is a typical symptom for most major diseases, like heart disease, many types of cancer, autoimmune diseases such as lupus and multiple sclerosis, and anemia (too few red blood cells). Fatigue also is a common sign of depression and anxiety. And fatigue is a side effect of some medications.

Drink enough water If your body is short on fluids, one of the first signs is a feeling of fatigue. Although individual needs vary, the Institute of Medicine recommends men should aim for about 15 cups (3.7 liters) of fluids per day, and women about 12 cups (2.7 liters). Besides water and beverages like coffee, tea and juices, you can also get your fluids from liquid- – Harvard Health Letters heavy fruits and vegetables that are up Diet to 90 percent water, such as cucumbers, Boost your ATP with fatty acids and zucchini, squash, strawberries, citrus protein from lean meats like chicken and fruit and melons.

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APRIL 2019 | OR TODAY |

INDEX

advertisers

Alphabetical Action Products, Inc.……………………………………… 23 AIV Inc.……………………………………………………………… 63 ALCO Sales & Service Co.……………………………… 70 Arthroplastics, Inc.………………………………………………13 ASCA………………………………………………………………… 70 Avante Patient Monitoring……………………………… 47 C Change Surgical……………………………………………… 6 Calzuro…………………………………………………………………15 Capital Medical Resources……………………………… 70 Cygnus Medical…………………………………………………… 9

Diversey ………………………………………………………………61 Healthmark Industries Company, Inc.…………… 4 Innovative Medical Products………………………… BC Jet Medical Electronics Inc…………………………… 23 MAC Medical, Inc……………………………………………… 32 MD Technologies inc.………………………………………IBC Medline………………………………………………………… 24-25 MedWrench……………………………………………………… 52 Microsystems……………………………………………………… 5 Mobile Instrument Service & Repair…………… 67

Molnlycke Health Care…………………………………… 57 O2COOL…………………………………………………………… 29 oneSOURCE Document Site………………………… 64 OR Today Webinar Series……………………………… 46 Ruhof Corporation…………………………………………… 2-3 Soma Technology………………………………………………21 Soothing Scents………………………………………… 48-51 TBJ Incorporated……………………………………………… 53 TIDI……………………………………………………………………17, 19 USOC Medical…………………………………………………… 26

ANESTHESIA

INFECTION CONTROL

Molnlycke Health Care…………………………………… 57

Soma Technology………………………………………………21

REPAIR SERVICES

Soma Technology………………………………………………21

ALCO Sales & Service Co.……………………………… 70 Cygnus Medical…………………………………………………… 9 Diversey ………………………………………………………………61 Healthmark Industries Company, Inc.…………… 4 Medline………………………………………………………… 24-25 Ruhof Corporation…………………………………………… 2-3 TBJ Incorporated……………………………………………… 53 TIDI……………………………………………………………………17, 19

CARDIAC

INSTRUMENT STORAGE/TRANSPORT

categorical ASSET MANAGEMENT Microsystems……………………………………………………… 5

ASSOCIATION ASCA………………………………………………………………… 70

C-ARM

C Change Surgical……………………………………………… 6 Jet Medical Electronics Inc…………………………… 23

Cygnus Medical…………………………………………………… 9 TIDI……………………………………………………………………17, 19

CARTS/CABINETS

INSTRUMENT TRACKING

ALCO Sales & Service Co.……………………………… 70 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 4 MAC Medical, Inc……………………………………………… 32 TBJ Incorporated……………………………………………… 53

Microsystems……………………………………………………… 5

CS/SPD

ONLINE RESOURCE

MD Technologies inc.………………………………………IBC Microsystems……………………………………………………… 5

MedWrench……………………………………………………… 52 oneSOURCE Document Site………………………… 64 OR Today Webinar Series……………………………… 46

DISINFECTION Cygnus Medical…………………………………………………… 9 Diversey ………………………………………………………………61 Ruhof Corporation…………………………………………… 2-3

ENDOSCOPY Capital Medical Resources……………………………… 70 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 4 MD Technologies inc.……………………………………… 75 Mobile Instrument Service & Repair…………… 67 Ruhof Corporation…………………………………………… 2-3

FLUID CONTROL Arthroplastics, Inc.………………………………………………13

FOOTWEAR

MONITORS Avante Patient Monitoring……………………………… 47 Soma………………………………………………………………………21 USOC Medical…………………………………………………… 26

OR TABLES/BOOMS/ACCESSORIES Action Products, Inc.……………………………………… 23 Innovative Medical Products………………………… 76 Soma………………………………………………………………………21

OTHER AIV Inc.……………………………………………………………… 63 O2COOL…………………………………………………………… 29 Soothing Scents………………………………………… 48-51

PATIENT MONITORING AIV Inc.……………………………………………………………… Avante Patient Monitoring……………………………… Jet Medical Electronics Inc…………………………… USOC Medical……………………………………………………

63 47 23 26

Calzuro…………………………………………………………………15

POSITIONING PRODUCTS

GENERAL

Action Products, Inc.……………………………………… 23 Cygnus Medical…………………………………………………… 9 Innovative Medical Products………………………… BC Molnlycke Health Care…………………………………… 57

AIV Inc.……………………………………………………………… 63 Capital Medical Resources……………………………… 70

HOSPITAL BEDS/PARTS ALCO Sales & Service Co.……………………………… 70

74 | OR TODAY | APRIL 2019

PRESSURE ULCER MANAGEMENT Action Products, Inc.……………………………………… 23

Avante Patient Monitoring……………………………… 47 Capital Medical Resources……………………………… 70 Cygnus Medical…………………………………………………… 9 Jet Medical Electronics Inc…………………………… 23 Mobile Instrument Service & Repair…………… 67 Soma Technology………………………………………………21

REPROCESSING STATIONS TBJ Incorporated……………………………………………… 53

RESPIRATORY Soma………………………………………………………………………21

SAFETY Calzuro.com…………………………………………………………15 Healthmark Industries Company, Inc.…………… 4 TIDI……………………………………………………………………17, 19

SINKS TBJ Incorporated……………………………………………… 53

STERILIZATION Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 4 TBJ Incorporated……………………………………………… 53

SURGICAL MD Technologies inc.……………………………………… 75 Soma………………………………………………………………………21 TIDI……………………………………………………………………17, 19

SURGICAL INSTRUMENT/ACCESSORIES C Change Surgical……………………………………………… 6 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 4

TELEMETRY AIV Inc.……………………………………………………………… 63 Avante Patient Monitoring……………………………… 47 USOC Medical…………………………………………………… 26

TEMPERATURE MANAGEMENT C Change Surgical……………………………………………… 6 MAC Medical, Inc……………………………………………… 32

WASTE MANAGEMENT Arthroplastics, Inc.………………………………………………13 MD Technologies inc.……………………………………… 75 TBJ Incorporated……………………………………………… 53

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